: Reason: Relinquished Custody signature: Printed Name/Agency Reason Accepted Custody Date and Time Date and Time Signature: Printed Name/Agene. Reason: Signature: Printed Name/Agency: Reason: Relinquished Custody Date and Time Accepted Custody Date and Time Signature: Printed Nam

Printed Name/Agency: Reason: Reason: Relinquished Custody Date and Time Accepted Custody Date and Time Signature: Signature: Printed Name/Agene): Printed Name/Agency: Reason: Reason: Relinquished Custody Date and Time Accepted Custody Date and Time Signature: Signature: Printed Na

VIDENCE CHAIN OF CUSTODY Relinquished Custody D Time Accepted Custody Date and Time Signature: Signature: -81.21 .1 _ U :6912 Printed Name/Agene Printed N ,, R Reason: 5 Ifietirergfit0.11a Relinquished Custody Date and Time Accepted Custody Date and Time .5/0)/3 a If .:50c; S.

Printed Name/Agency: Reason: Reason: Relinquished Custody Date and Time Accepted Custody Date and Time Signature: Signature: Printed Name/Agene): Printed Name/Agency: Reason: Reason: Firearm Certification by (FUSWAT) I Explosive Material Certification by (SABT): Printed Name: Signature:

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— - I Date and Time Silehl 3 .y 0004 Special Handling Instructions Initial Receipt Il HAZMAT O Latcnts O Fal Signature of Seizing Name/Agene I • Req. Charging O Freeze O Refrigerate Printed • Biohazard Reason: Initial Colic I By: O Other Collected Agency: Fel l Relinquished C