STATE OF INDIANA | ) | |
) | SS: | |
COUNTY OF ___________________ | ) |
A B swears (or affirms, as the case may be) that he believes and has good cause to believe (here set forth the facts and information constituting the probable cause) that (here describe the things to be searched for and the offense in relation thereto) are concealed in or about the (here describe the house or place) of C D, situated in the county of _____________________, in said state.
In accordance with Indiana Trial Rule 11, I affirm under the penalties for perjury that the foregoing representations are true.
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(Signed) Affiant Date
IC 35-33-5-2