Fill and Sign the Claim Affidavit Form

STATE OF LOUISIANA : _______ JUDICIAL DISTRICT COURT VS : PARISH OF _______ , LOUISIANA _______________ , _______________ AND $ _______ : DOCKET NO. _______ _________________________________________________________________ _ CLAIM/AFFIDAVIT On _______ ___ , 20 ___ , the _______ Parish Sheriff's Office seized the following property belonging to me: $ _______ . I, _______________ , assert herein that I am the owner of the aforementioned legal property. Affiant assumes that this property was seized for forfeiture pursuant to La. R.S. 40:2600 et seq. (hereinafter referred to as "Act"). Affiant assumes that the seizing officers erroneously concluded that he was guilty of conduct giving rise to forfeiture under Section 2603 of the "Act" or that his property was property subject to forfeiture under Section 2604 of the "Act". Affiant asserts herein that at the time of the seizure he was not guilty of conduct giving rise to forfeiture. Additionally, Affiant asserts that this property is not property subject to forfeiture under La. R.S. 40:2604, and that at the time of its seizure, it was not a controlled dangerous substance, nor was it used or intended to be used in any manner to facilitate conduct giving rise to forfeiture under La. R.S. 40:2600 et seq., nor is it a weapon possessed, used or available for use in any manner to facilitate conduct giving rise to forfeiture, nor is it any interest or security in claim against or property or contractual right of any kind affording a source of control over any enterprise that a person has established, operated, controlled, conducted or participated in as conduct giving rise to forfeiture. My mailing address is _______________ . At this time, Affiant specifically invokes his right against self-incrimination as guaranteed to him in the Fifth Amendment of the United States Constitution and Article l, Section l6, of the Louisiana Constitution, and declines to give further evidence against himself. Additionally, Affiant suggests that due process requires that he be informed of all further proceedings and specifically request to be notified of any further legal proceedings involving this property which is currently being held by the _______ Parish Sheriff's Department. Affiant also requests that the _______ Parish Sheriff's Department release his property to him immediately. THUS DONE AND SIGNED in the presence of the undersigned competent witnesses and me, Notary Public in and for the Parish of _______ , _______ , on this _____ day of _______ 20 ___ , after reading of the whole. WITNESSES: ____________________________ _______________________________ _______________ ____________________________ _________________________________ NOTARY PUBLIC MY COMMISSION EXPIRES: ______________