DISTRICT COURT OF MARYLAND FOR Located at Court Address Complainant Address City, State, Zip Defendant Address City, State, Zip City/County Case No. COMPLAINT AND AFFIDAVIT APPLICATION FOR FORFEITURE OF CONTRABAND MONEY (Md. Rules 3-121 and 3-307) THE Forfeiting Authority MAKES APPLICATION FOR: Person/Agency The seized monies now in possession of in the amount of $ described as: cash check (s) seized on at about Date AM other PM at the location known as these seized monies believed to be the property of the above name Defendant. The facts and circumstances surrounding the seizure are: THE FORFEITING AUTHORITY ALLEGES THE SPECIFIC GROUNDS FOR FORFEITURE ARE: The seizure was incident to an arrest of the Defendant. The seizure was incident to a search under search warrant of premises to which the Defendant did have connection; The seizure was incident to an inspection under an administrative inspection warrant; The seizure amount reflects in part in whole a prior judgment awarded the State in a criminal injunction forfeiture proceeding; There is probable cause to believe the monies have been used or were intended for use in connection with illegal controlled dangerous substances gambling activity, for which the Defendant was charged in the District Court of Maryland the Circuit Court for on , Criminal Case Number . Date The criminal charges were finally disposed of on by conviction probation before judgment not guilty verdict dismissal nolle prosequi stet. Final disposition of criminal charges is not a condition precedent to filing forfeiture proceedings. THE FORFEITING AUTHORITY AFFIRMS: I do solemnly declare and affirm that under the penalties of perjury that the contents of this Complaint are true to the best of my knowledge, information, and belief. Date Signature of Authorized Representative of Forfeiting Authority Printed Name Title Agency Address City, State, Zip Telephone Number E-mail Fax NOTICE TO DEFENDANT The complaint and application for forfeiture of contraband money has been filed with the Court. The seized monies described herein shall be forfeited if no answer to this complaint is timely filed. Any answer shall comply with Maryland Rules and must be filed with the Court at the address shown above. For additional information concerning the forfeiture, contact the forfeiting authority. DC-024 (Rev. 10/2014) American LegalNet, Inc. www.FormsWorkFlow.com