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OFFICE OF DISTRICT ATTORNEY COUNTY OF CORTLAND 37 Church Street Cortland, New York 13045 (607) 753-5008 Email at: DISTRICT ATTORNEY Hon. Patrick A. Perfetti PROPERTY RELEASE FORM Name of Person Seeking Release of Property: Address: Home/Cell Case / Dkt # Defendant(s): Charge(s): Police Agency: Property to be Released: Are you the Owner of the Property? YES NO Note: IF YOU ARE NOT THE PROPERTY OWNER, BUT HAVE BEEN DESIGNATED BY THE PROPERTY OWNER TO RECOVER HIS/HER PROPERTY, YOU MUST OBTAIN THE SIGNATURE OF THE PROPERTY OWNER IN THE SPACE BELOW AND YOU MUST AFFIRM UNDER PENALTY OF PERJURY THAT YOU IN FACT HAVE BEEN DESIGATED TO RECOVER THE PROPERTY BY THE OWNER. AUTHORIZATION OF PROPERTY OWNER AUTHORIZING DESIGNEE TO RECOVER PROPERTY I AM THE OWNER OF THE PROPERTY SOUGHT TO BE RELEASED. I HEREBY REQUEST THE RETURN OF THE ABOVE PROPERTY. PLEASE RELEASE THE ABOVE PROPERTY TO MY AUTHORIZED DESIGNEE: Name of Property Owner: Name of Authorized Designee: Relationship to Property Owner: Signature of Property Owner: ---PAGE BREAK--- AFFIRMATION OF PROPERTY OWNER OR DESIGNEE I AM THE OWNER OF THE PROPERTY SOUGHT TO BE RELEASED OR HIS/HER DESIGNATED REPRESENTATIVE AUTHORIZED BY THE OWNER TO RECOVER HIS/HER PROPERTY. AFFIRMED UNDER PENALTY OF PERJURY THIS DAY OF Signature Identification Provided False Statements made herein are punishable as a Class A Misdemeanor pursuant to New York State Penal Law section 210.43. FOR DISTRICT ATTORNEY OFFICE USE ONLY: CASE / Dkt#: RELEASED CLEARED BY LAW & APPEALS: RELEASE APPROVED: RELEASE NOT APPROVED: Special Instructions to Police Agency Prior to Release: ( ) Photograph Property ( ) List Serial # of Property ( ) Other Date: BY Assistant District Attorney: