County of _______________, state of Arizona, to any peace officer accompanied by an adult protective services worker in the state of Arizona, proof, by affidavit attached hereto and made a part hereof for all purposes, having been this day made before me (by person or persons where affidavit has been taken) that there may exist a reasonable governmental interest to determine if _______________, an adult, may be incapacitated and abused, exploited or neglected. You are therefore commanded in the daytime to visit the residence of _______________, an adult, located at _______________, in the county of __________________, state of Arizona, and to visit ____________________ for the purpose of making a determination if the adult is in need of protective services and what services, if any, are needed.
Given under my hand and dated this ______________ day of _________, 19__.
(signature)
__________________________________
Judge of the superior court
(The endorsement on the warrant shall be:)
Received by us this __________ day of ______________, 19__, at the hour of _____________ a.m./p.m.
A peace officer
Adult protective services worker
Department of economic security
(Return of the warrant shall be:)
We hereby certify that by virtue of the within warrant we visited _______________, and visited his/her residence located at ______________, on the _________ day of _______, 19__, at the hour of ______ a.m./p.m. and found the following:
Dated this __________ day of ___________________________, 19__. ______________________________________ A peace officer ______________________________________ Adult protective services worker
A.R.S. § 14-5310.01