DALLAS COUNTY OFFICE OF THE MEDICAL EXAMINER

EVIDENCE SUBMISSION

Complete this form for each case; write legibly.

Seal drug evidence in tamper evident container and initial all non-factory seals.
Place bar code on evidence bag. If more than one bag is submitted, place bar code on one
bag and write case number and case name on each additional bag.
Drop bag in Field Agent Drug Lockbox
Place this form in Drug Evidence Submission In-box next to lockbox.

Deceased Name: ____________________________________________________

Case Number: ______________________________________________________
Field Agent: _______________________________________________________
Date/Time of Submission: ____________________________________________
# Bags Submitted for this Case: ________________________________________
Description:

Comments

------------------------------------------------------------------------------------------------------Drug Evidence Registration:

(Date/Time) Stamp
Received _______ bag(s) from the Field Agent Drug Lockbox.
Received by: _______________________________________