AFFIDAVIT FOR SEARCH WARRANT Commonwealth of Virginia VA. CODE § 19.2-54 FILE NO. The undersigned Applicant states under oath: 1. A search is requested in relation to an offense substantially described as follows: APPLICANT: AFFIDAVIT FOR SEARCH WARRANT ........................................................................................................................... NAME ........................................................................................................................... TITLE (IF ANY) ADDRESS ........................................................................................................................... ........................................................................................................................... ................................................................................................................................................................................................................................... Certified to Clerk of ............................................................................................... [ ] CONTINUED ON ATTACHED SHEET Circuit Court CITY OR COUNTY 2. The place, person or thing to be searched is described as follows: on ..................................................................................................................... DATE ............................................ TITLE ..................................................................... SIGNATURE Original Delivered [ ] in person [ ] by certified mail [ ] by electronically transmitted facsimile [ ] by use of filing/security procedures defined in the Uniform Electronic Transactions Act ................................................................................................................................................................................................................................... to Clerk of on ........................................................................ CITY OR COUNTY WHERE EXECUTED Circuit Court [ ] CONTINUED ON ATTACHED SHEET ..................................................................................................................... DATE 3. The things or persons to be searched for are described as follows: ............................................ TITLE _________________________________ SIGNATURE Complete only if different than above: Copy delivered [ ] in person [ ] by certified mail [ ] by electronically transmitted facsimile [ ] by use of filing/security procedures defined in the Uniform Electronic Transactions Act ................................................................................................................................................................................................................................... to Clerk of on ........................................................................ CITY OR COUNTY OF ISSUANCE Circuit Court [ ] CONTINUED ON ATTACHED SHEET (OVER) FORM DC-338 (MASTER, PAGE ONE OF TWO) 07/12 ..................................................................................................................... DATE ............................................ TITLE _________________________________ SIGNATURE American LegalNet, Inc. www.FormsWorkFlow.com 4. The material facts constituting probable cause that the search should be made are: ......................................................................................................................................................................................................................................................................................................................................................... 5. The object, thing or person searched for constitutes evidence of the commission of such offense. 6. [ ] I have personal knowledge of the facts set forth in this affidavit OR 7. [ ] I was advised of the facts set forth in this affidavit in whole or in part, by a person whose credibility or the reliability of the information may be determined from the following facts: ......................................................................................................................................................................................................................................................................................................................................................... The statements above are true and accurate to the best of my knowledge and belief. ................................................................................................................................................. TITLE OF APPLICANT ____________________________________________________________________________________ APPLICANT Subscribed and sworn to before me this day. ................................................................................................................................................. DATE AND TIME ____________________________________________________________________________________ [ ] CLERK [ ] MAGISTRATE [ ] JUDGE FORM DC-338 (MASTER, PAGE TWO OF TWO) 10/11 American LegalNet, Inc. www.FormsWorkFlow.com