Fill and Sign the Code 27 32 Form

AFFIDAVIT FOR FIRE INVESTIGATION WARRANT Commonwealth of Virginia VA. CODE § 27-32.2 The undersigned Applicant states under oath that: 1. A fire or explosion occurred on .............................. on [ ] land [ ] building [ ] vessel [ ] other object located at DESCRIPTION/LOCATION OF PLACE TO BE INSPECTED ........................................................................\ ...................................................................................................................... 2. The origin or cause of the fire or explosion has not been determined. 3. I have been refused admittance or have been unable to gain permission to enter the above-described land, bu ilding, or vessel or to examine the object described herein within 15 days following the exti nguishment of the fire or explosion. The facts that support the above statement are as follows: ........................................................................\ ...............................................................................................................................\ .................. [ ] Continued on attached sheet I request the issuance of a fire investigation warrant to enable the investigation of the origin and source of the fire or explosion. ........................................................................\ ......... ____________________________________________________________ TITLE OF APPLICANT APPLICANT SIGNATURE Subscribed and sworn to before me this day: ........................................................................\ .........____________________________________________________________ DATE AND TIME MAGISTRATE AFFIDAVIT FOR FIRE INVESTIGATION WARRANT Applicant: ........................................................................\ ............................................................... NAME ........................................................................\ ............................................................... TITLE ........................................................................\ ............................................................... ADDRESS ........................................................................\ ............................................................... Certified to Clerk of ........................................................................\ ....................... Circuit Court CITY OR COUNTY on ........................................................................\ ............................................. DATE ............................................ _______________________________________ TITLE SIGNATURE Original Delivered [ ] in person [ ] by certified mail [ ] by electronically transmitted facsimile [ ] by use of filing/security procedures defined in the Uniform Electronic Transactions Act to Clerk of ........................................................................\ ............ Circuit Court CITY OR COUNTY WHERE EXECUTED on ........................................................................\ .............................................. DATE ............................................ _______________________________________ TITLE SIGNATURE FORM DC-376 MASTER 07/17