Sample Format of Evidence Custodian Report

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
______________________________________

_______________________

RECEIPT OF EVIDENCE CONFISCATED

THIS IS TO CERTIFY that the undersigned receiving Police Officer seized/

confiscated the following described properties/ items from the custody and control of
______________________________________, by virtue of Search Warrant
No.________ issued by Honorable Judge
________________________________,Executive/ Presiding Judge of Branch ______,
RTC, ____________________ dated ___________________ for Violation of
___________________________:

PROPERTIES/ ITEMS CONFISCATED

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_________________________________________________________

SIGNED IN THE PRESENCE OF:

1.) ____________________________

2.) _____________________________

_____________________________
(Evidence Custodian)