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Laboracory
Texas Department of Public Safety

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It is requested that an examination be made to determine:

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Case Record Information:

Offense:
Date of OffenSi'e:
County of Offensel
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Suspect: Full naae, color, sex, age
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Victim: Full name, color., sex, age
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Please send copy of report to:

(Name)

1 . D. Koatkoisar;^ °' * * * °*^"^'"*°*' °^^*''

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