SECTION II - FORFEITURE EXPENSES

Date/Check No.

(Local Use)

Type of Expense e.g. Returned Money, Shared Money, Tow

Charge, Storage, Auction Cost, PA FeePayee Amount

Name

Address

SS#, Fed. ID#

or Vendor ID#

Name

Address

SS#, Fed. ID# or Vendor ID#

Name

Address

SS#, Fed. ID#

or Vendor ID#

Name

Address

SS#, Fed. ID#

or Vendor ID#

Name

Address

SS#, Fed. ID#

or Vendor ID#

Distribution:

Original - Financial Services Upon Completion of

Forfeiture Machine Copy - Master File

CID-015A (01/2019)

Michigan State Police

FORFEITURE CASH/EXPENSE REPORT (Not to be used for Returned Property or Property kept for Official Use)

Incident No.

Date Seized

Forfeiture Action: Administrative Circuit Court (attach court order) Refused

Forfeiture Statute: Controlled Substances Federal Controlled Substances Auto Theft Omnibus Gambling

SECTION I - RECORD OF CASH DEPOSITS

Property Item No.

Brief Description of Property (cash,

car, jewelry, etc.). Date of Sale

Date Cash Deposited

ADM-027 Receipt

Date Adjudicated Cash Amount

DateAuthorized By (Signature)

Authority: MCL 333.7523Compliance: Voluntary