Evidence Chain of Custody Tracking Form

Description of Evidence

Item #

Quantity

Description of Item (Model, Serial #, Condition, Marks, Scratches)

1

1

  Verbatim USB Drive, black, 2.0GB, Serial #23097JR2. Marked as “USB02_032816_4-2”.

Chain of Custody

Item #

Date/Time

Released by
(Signature & ID#)

Received by
(Signature & ID#)

Comments/Location

1

08/21/16

PI Smith, #351

Examiner, #891920

Released for processing at forensics lab.

1

08/22/16

Examiner, #891920

Jane Smith, evidence custodian

Secured in evidence locker awaiting final disposition.

Chain of Custody

Item #

Date/Time

Released by
(Signature & ID#)

Received by
(Signature & ID#)

Comments/Location

Final Disposal Authority

Authorization for Disposal

Item(s) #: __________ on this document rtaining to (susct): ____________________________________________
is(are) no longer needed as evidence and is/are authorized for disposal by (check appropriate disposal method)
☐ Return to Owner          ☐ Auction/Destroy/Divert
Name & ID# of Authorizing Officer: ____________________________ Signature: ______________________Date: _______________

Witness to Destruction of Evidence

Item(s) #: __________ on this document were destroyed by Evidence Custodian ___________________________ID#:______
in my presence on (date) __________________________.

Name & ID# of Witness to destruction: ________________________ Signature: ______________________Date: _______________

Release to Lawful Owner

Item(s) #: __________ on this document was/were released by Evidence Custodian ________________________ID#:_________ to
Name _____________________________________________________________________________
Address: ________________________________________________ City: ____________________State: _______ Zip Code: __________
Telephone Number: (_____) ___________________________________
Under nalty of law, I certify that I am the lawful owner of the above item(s).

Signature: _______________________________________________________ Date: __________________________

Copy of Government-issued photo identification is attached. ☐ Yes  ☐ No

This Evidence Chain-of-Custody form is to be retained as a rmanent record by the Anywhere Police Department.