Family Violence Initiative

Sample Return (ss. 117.04(3)(b))

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NOT AN OFFICIAL FORM

Included only as guidelines for assistance with Criminal Harassment cases. For further information contact the National Weapons Enforcement Support Team (NWEST)
at1-800-731-4000 Ext 2053.

RETURN

WHEREAS on  day, the  day of  , 20 ,  , a peace officer searched for any firearm, weapon, prohibited device, ammunition, explosive substance or any authorization, licence or registration certificate relating to any such thing, pursuant to section 117.04 (2) of the Criminal Code, that was held by or in the possession of .

AND WHEREAS the peace officer was satisfied that there were reasonable grounds for believing that it was not desirable in the interests of safety of  , that   should possess any weapon, prohibited device, ammunition, prohibited ammunition, explosive substance or any authorization, licence or registration certificate relating to any such thing and that the danger to the safety of   was such that to proceed by way of an application under Section 117.04(1) of the Criminal Code was not practicable.

THE GROUNDS on which it was concluded that the peace officer who conducted the said search was entitled to do so without warrant are as follows:
 
 

THE ARTICLES SEIZED are listed in Schedule A attached hereto.

DATED at  , this   day of  , 20 .



TO:  (court)

Or

A Justice of the Peace