17.1 Section 17 is promulgated pursuant to A.C.A. § 26-57-247(j)(6).

17.2 For purposes of forfeiture tracking, each law enforcement agency seizing property pursuant to A.C.A. § 26-57-247 shall be assigned a unique numeric identifier.

17.3 FORM ATC-C10 is hereby adopted as standardized confiscation report form to be used by all law enforcement agencies when forfeitable property is confiscated pursuant to A.C.A. § 2657-247 as follows:

Date & Time of seizure:____________________________ County of seizure: ___________________

Name & Address of persons from whom the property was seized:

________________________________________________

________________________________________________

________________________________________________

________________________________________________

Seizing Officer: ___________________________________

REASON OR BASIS FOR SEIZURE: (Check all applicable)

​ VEHICLE (or other conveyances) used or intended for use to transport untaxed tobacco product.

​ MONEY furnished or intended to be furnished in exchange for untaxed tobacco product or profits and proceeds traceable to such exchange or found in close proximity to a forfeitable tobacco product or a forfeitable record of an importation of a tobacco product, or used to facilitate a criminal violation of the Tobacco Products Tax Act of 1977 or the Unfair Cigarette Sales Act.

​ FIREARMS furnished or intended to be furnished in exchange for a tobacco product in violation of the Tobacco Products Tax Act of 1977 OR explain other basis for seizure (e.g. stolen firearm, felon in possession, etc...):_________

____________________________________________________________ OTHER

PROPERTY seized and basis for seizure:

DESCRIPTION AND ESTIMATED VALUE OF PROPERTY SEIZED:

(must contain serial and model numbers, if applicable, must contain odometer or hour meter if vehicle or equipment)

PROPERTY SEIZED WILL BE HELD AT THE FOLLOWING LOCATION(S). ____________________________________________________________

The undersigned officer states that he/she is the “seizing officer” and that this report is true and complete.

___________________________________________________

Signature of seizing officer

The undersigned hereby states that he/she is the person(s) from whom the above property was seized and that his/her correct mailing address is given below.

____________________________________________________

Signature

Printed name & mailing address:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

In the event that a party refuses to sign, the following must be completed:

The undersigned additional law enforcement officer hereby states that the party from whom the property was seized refused to sign this report and I hereby place my signature attesting to such refusal.

____________________________________________________

Signature of secondary officer

The undersigned agent hereby certifies that he has sent a copy of this report to the Prosecuting Attorney and has obtained and is maintaining a copy of this report that has been acknowledged as being received by:___________________________ and further certifies that he has sent a copy of the foregoing to the Arkansas Tobacco Control Director on this ______day of ________________, 20______.

______________________________________________________

Signature of seizing officer

The Prosecuting Attorney's Office acknowledges receipt of a copy of the foregoing on this ______day of________________, 20______.

(must be signed by the Prosecuting Attorney or deputy prosecuting attorney.)

_______________________________________________________

Signature of PA

17.4 A report number for each seizure shall be assigned by ATC and recorded on the FORM ATC-C10 that will be completed by the seizing law enforcement agency.

17.5 The report number shall consist of the calendar year, the LEA numeric identifier, and the sequential confiscation number for that calendar year. (e.g. 2010001001)