Evidence Custody Document

EVIDENCE / PROPERTY CUSTODY DOCUMENT

The proponent agency for this document is OHMR-PM CONTROL NUMBER

REPORT CROSS-REFERENCE NUMBER

RECEIVING AGENCY

Makestuff IT Security LOCATION

Makestuff Remote Office #4

NAME, GRADE AND TITLE OF PERSON FROM WHOM RECEIVED OWNER Former work area of Mr. YOURPROP

OTHER ADDRESS (Includes ZIP Code)

Bldg# 47, Martin Blvd, Faketown, NJ 12345

LOCATION FROM WHERE OBTAINED

Desk near west wall of office REASON OBTAINED

Evaluation as evidence TIME / DATE OBTAINED

1430, 04/01/2014

ITEM NO. QUANTITY DESCRIPTION OF ARTICLES

(Include model, serial number, conditions, and any unusual marks or scratches)

1

2

3

--------- 1

1

1

-------------- Voice recorder, small, silver, Olympus.

Western Digital, 1TB, silver and black with a green label, roughly rectangular, affixed with a torn sticker on the front.

Thumb drive, USB, PNY-brand, 64GB in size, unknown serial number, grey and black in color, approximately 1” x 2.5” x 0.5”, metal and plastic-type construction, printed with “PNY… 64GB”, with small hole on the side (which appears to be for a lanyard.

--------------------------///LAST ITEM///---------------------------------------------------------------

CHAIN OF CUSTODY

ITEM NO.

DATE

RELEASED BY

RECEIVED BY

PURPOSE OF CHANGE OF CUSTODY

1-3

04/01/2014 SIGNATURE

CRIME SCENE SIGNATURE

///original signed///

Evaluation as evidence

NAME, GRADE, TITLE

N/A NAME. GRADE, TITLE

I.M. Helpful, Security Specialist

SIGNATURE SIGNATURE

NAME, GRADE, TITLE NAME. GRADE, TITLE

SIGNATURE SIGNATURE

NAME, GRADE, TITLE NAME. GRADE, TITLE

SIGNATURE SIGNATURE

NAME, GRADE, TITLE NAME. GRADE, TITLE

NAME, GRADE, TITLE NAME. GRADE, TITLE

SIGNATURE SIGNATURE

OHMR FORM 4137 front (Jul 91)