Chain of Custody Form
Case Number
Offense
Victim
Suspect
Submitting Officer Name
First Name
Last Name
Submitting Officer ID #
Submitting Officer Position
Date and Time Seized
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Location of Seized
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Evidence/Article Description
Rows
Item #
Item Description
Condition
Quantity
1
2
3
4
5
6
Chain of Custody
Rows
Item #
Date & Time
Received by (Name & Position)
Released By (Name)
Remarks/Notes
1
2
3
4
5
6
7
8
9
10
11
12
Releasing Officer Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Receiver Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: