FORM 5.07
(Subsection 487.057(1))
REPORT TO A PROVINCIAL COURT JUDGE OR THE COURT

Canada,
Province of ................,
(territorial division)

[ ] To (name of judge), a judge of the provincial court who issued a warrant under section 487.05 or granted an authorization under section 487.055 or 487.091 of the Criminal Code or to another judge of that court:

[ ] To the court from which an order under section 487.051 or 487.052 of the Criminal Code was made:

I, (name of peace officer), have (state here whether you have acted in execution of a warrant under section 487.05 or an order under section 487.051 or 487.052, or under an authorization under section 487.055 or 487.091) of the Criminal Code.

I have (state here whether you have taken the samples yourself or caused them to be taken under your direction) from (name of offender) the number of samples of bodily substances that I believe are reasonably required for forensic DNA analysis, in accordance with (state whether the taking of the samples was under the warrant issued or an authorization granted by the judge or another judge of the court or an order made by the court).

The samples were taken at .... a.m./p.m. on the ... day of ........... A.D.......

I (or state the name of the person who took the samples) was able by virtue of training or experience to take the following samples from (name of offender) in accordance with subsection 487.06(1) of the Criminal Code and did so take them:

• individual hairs, including the root sheath
  
• epithelial cells taken by swabbing the lips, tongue or inside cheeks of the mouth
  
• blood taken by pricking the skin surface with a sterile lancet Any terms or conditions in the (warrant, order or authorization) have been complied with.

Dated this ................ day of ................
A.D. ........, at ................ .
........................................
(Signature of peace officer)