CONSENT TO SEARCH

(Date)

(Location)

I, , having been informed of my Constitutional

right not to have a search made of the premises hereinafter mentioned without a search warrant and of my
right to refuse to consent to such a search, hereby authorize
and to conduct a complete search of my
premises located at . The above mentioned individuals are
authorized by me to take from my premises any letters, papers, materials, or other property that they might
desire.

This written permission is being given by me voluntarily and without threats or promises of any
kind.

(Signed)

WITNESSES:

This is to certify that on at ,

the individuals described above, conducted a search of ____.
I certify that nothing was removed from my custody.

(Signed)

Witnessed:
 CONSENT TO SEARCH

On (date) item(s) listed below were:

___ Received from
___ Returned to
___ Released to

Name
Street Address
City

Description of
Item (s):

Received by:

Received from: