CID-014 (11/2018) Michigan State Police

Seizing Law Enforcement Agency Phone Number

- Location to File Claim Address

Address Where Seized: Number and Street City State Zip Code

Description of Property - Describe Fully

(Manufacturer/Make/Serial No. - Denomination/Amount of Money)

Claim Deadline Date Seized

Incident No. AUTHORITY: MCL 333.7523 COMPLIANCE: Required PENALTY: Return of property to owner

Value of PropertyProperty

Number

NOTICE OF CLAIM

Name of Claimant Work Phone Home Phone

Address: Number and Street City State Zip Code

Signature of Claimant Date Signed

Claimant's Interest in the Property

RECEIPT OF CLAIM

Printed Name of Person Receiving Claim Work Unit

Signature of Person Receiving Claim Date Received Time

DISTRIBUTION:

Original - Master File

Machine Copy - Claimant

Machine Copy - Financial Services

*THIS INFORMATION IS

CONFIDENTIAL

DISCLOSURE OF CONFIDENTIAL

INFORMATION IS PROTECTED BY

THE FEDERAL PRIVACY ACT.