I, _____________________________________________, have been informed of my constitutional right not to have a search made of my premises, motor vehicle, or other property without a search warrant. No promises, threats, duress, or coercion have been made to me or against me. Having been informed of my right to refuse to consent to such a search, and understanding that evidence and/or contraband found as a result of such may be seized and used against me in a court of law, I hereby authorize: _____________________________________________, a police officer, or any law enforcement officer, to conduct a complete search of: 

          My premises, and all property found therein, located at: ____________________________________             _______________________________________________________________________________

         My motor vehicle, a (Year) ________, (Make/Model )__________________, (VIN)_______________________

bearing license plates _____________________________, issued by the State of ________________

and all property found therein. This vehicle is currently located at: __________________________


  • My personal computer or electronic storage devices(s) and my authorization to the above stated person, any law enforcement officer or agent to seize, listen to, look at, read, review, copy, print and maintain any and all data which is in electronic machine readable media and to convert it to human readable form as necessary.

I am giving this written permission to the above named police officers voluntarily. No promises, threats, duress, or coercion have been made to me or against me.

Signed _____________________________________________________ Date ______________________

                                                                                                             Time _____________a.m. / p.m.       

Witness (Print Name)________________________________ (Sign)__________________________________

Witness (Print Name)________________________________ (Sign)__________________________________


Subject name ___________________________________________________________________________

Address _______________________________________________________________________________

City ______________________ State ___________ Zip ____________ Telephone ___________________

Understands rights  Yes  No                                    Questions concerning rights  Yes  No

Can read and write  Yes  No                                   Alcohol or drug use  Yes  No