Client Name__________________________________ Date___________ Time_________ Case # ________
Type of evidence submitted: Photo or video[__] Audio [__] Documentation [__] Physical [__]
Description, including condition: _______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Monetary value of specified evidence _______________________
The evidence you submit remains your property unless you choose to give it up. Is the evidence to be returned to
you after analysis is complete? Yes [__] No [__] (if yes, complete the destructive testing section below)
Turned over to investigator on: Date __________ Time ___________ Initial Seal Number ________________
Is permission granted for destructive testing? Yes [__] No [__]
(Note: if destructive testing is permitted, client is aware that the item may be damaged in some manner. The investigator will
attempt to keep such damage to a minimum, taking samples from small, inobtrusive areas of the specimen where possible. The
client is also aware that these samples may be destroyed in the course of testing and agrees to this process and will not hold
the investigator in any way responsible for this loss.)
I,__________________________________ agree [__] / Do not agree [__] to allow destructive testing to be
conducted on the material submitted as evidence.
The above stated evidence was received on: Date_________________ Time_______________.
by:______________________________, ________________________________.
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Evidence Return to Client
I ________________________________ acknowlege the above described evidence has been returned to me on:
Date__________________ Time _________________ Seal Number at time of return___________________.
It is unaltered and is in the same condition as when I surrendered it. YES [__] No [__].
If No, list discrepancies here. ________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
NOTE: Seal numbers may be different at time of return. The investigator will use Part B to track these numbers as the evidence is
being processed. By the use of both Part A (Client Section) and Part B (Investigator Section), a chain of evidence handling may
be followed. The client should inspect the evidence at the time of its return and note above any irregulaities that were not present
at the time the evidence was surrendered. Include any damage done in the course of testing.