Instructions 

◆ Part I must be completed by the state or local law enforcement officer responsible for the seizure. The officer must include

the name and title of the agency head or designated agency official who approved the request for adoption. Requests for

federal adoption of state or local seizures must be accompanied by both a detailed written description of the facts and 

circumstances establishing probable cause to seize the asset(s) and all pertinent documents and reports. Requests must be 

submitted to the federal investigative agency within 15 calendar days of the state or local seizure date unless 

circumstances merit a waiver.

◆ Part II should be completed and signed by the federal investigative agency counsel within 10 calendar days of receiving

this adoption request.

◆ Part III should be completed when the request includes seized cash equal to or less than $10,000.00 which does not meet

◆ Absent exceptional circumstances, the request for adoption must be approved prior to the transfer of the property to

Part I - To Be Completed by State or Local Officer Conducting the Seizure 

Name of Requesting Agency: 

NCIC/ORI Code of Requesting Agency: Requesting Agency Case #: 

Full Name: 

Telephone #: Ext.: Email:

Date of Seizure: Date of Request:

Location of Seizure Address:

City: State: Zip Code:

Seized Property Description(s) (If more than 3, please attach additional sheet) 

1. 

2. 

3. 

Seized From Parties (If more than 2, please attach additional sheet) 

1. Ext.: 

2. Ext.:

Circumstances of the Property Seizure

ATTACH ALL pertinent investigative & arrest reports, & copies of any affidavits filed in support of a search or arrest warrant. 

1. Property seized in conjunction with an arrest? Yes No 

2. Was property seized pursuant to a state or local warrant? Yes No 

3. Was an illegal controlled substance seized? Yes No 

4. Was other contraband besides controlled substances seized? Yes No 

5. Was there an admission of criminal activity associated with the seized property? Yes No 

6. Did the possessor deny ownership of the seized property? Yes No 

7. Was a firearm seized for forfeiture or retained as evidence of criminal activity? Yes No 

 

Full Name:

Incarcerated?: Yes 

Institution:

Home Address:

Full Name:

Incarcerated?: Yes 

Institution:

Home Address:

Telephone #:

No Date of Release (If Known):

No

Telephone #: 

Date of Release (If Known):

certain conditions and, therefore, requires additional review and approval by the U.S. Attorney’s Office. Part III should be

completed and signed by an Assistant U.S. Attorney (AUSA) within 5 calendar days of receiving this adoption request from 

the federal investigative agency.

federal custody.

8. Please identify whether there is audio or video recording of the seizure or the facts establishing probable cause in support

of that seizure: (e.g. "dashboard camera footage should be available")

Request for Adoption of State or Local Seizure 1 Version 2.0 - 7/26/2017
 

 

 

 

 

 

 


	

State Prosecution and/or Turnover Information

As a general rule, if a state or local agency has seized property as part of an ongoing state criminal investigation, and if the

1. Has a related state or local criminal case been initiated? Yes No 

(a) State or Local Case Number:

(b) State or Local Prosecutor:

2. Has a state forfeiture action been initiated for this property seized in the case? Yes No 

(a) State or Local Case Number:

(b) State or Local Prosecutor:

3. Has a state forfeiture action been initiated for other property seized in the case? N/A Yes No

(a) State or Local Case Number:

(b) State or Local Prosecutor:

4. Is this property subject to forfeiture under state law? Yes No 

5. Is a state turnover order or equivalent document required under state law? (Attach a copy when obtained) Yes No 

6. Does transfer of this property to the federal government comply with all state laws? Yes No 

Part II - To Be Completed by the Federal Investigating Agency (10 Calendar Days)

1. Date Request Received:

3. Does any of the property require USAO concurrence?

4.

Yes No 

Investigating agency approval to adopt? Yes No 

Reviewing Agency Counsel: 

Telephone #: Ext.: Email: 

Signature: Date: 

Part III - USAO Concurrence (5 Calendar days) 

USAO concurrence required only for cash/currency seizures equal to or under $10,000 and in addition, USAO 

concurrence only needed if questions 1 – 5 are all marked no in Part 1 - Circumstances of the Property Seizure. 

1. Date Request Received:

2. Do you concur with the federal adoption of this property? Yes No 

 Ext.: Email: 

AUSA Name:

Telephone #:

Signature: Date: 

Federal Use Only 

Asset ID: Case #: Seizure #: 

2

2. Are all pertinent investigative/arrest reports and affidavits included? No 

(c) Telephone #:

(c) Telephone #:

(c) Telephone #:

Part I Continued - To Be Completed by State or Local Officer Conducting the Seizure

criminal defendants are being prosecuted in state court, the forfeiture action should also be pursued in state court.

Yes 

Agency Head or Designated Agency Official Who Approved This Request

Full Name:

Title:

Request for Adoption of State or Local Seizure 2 Version 2.0 - 7/26/2017