Evidence origin information is required by the FBI to determine CODIS eligibility requirements. Form Effective: 10/2017
Form completed by:_______________________________________ Badge#:___________ Date of completion:___________________
Agency: Agency Case Number:
Officer/Det: Badge# DPS DR Number:
Direct Email: Direct Phone:
Offense(s): Trial Date:
1. Describe what happened in this case (or attach a short case summary):
2. How does each item submitted relate to the crime, and where was it found?
3. Identify the 5 most probative items:
4. If blood was present at the scene, how many people were bleeding? ______ How does each person relate to the crime?
5. What is believed to be the source of DNA for each item?
Source: Item Number(s)
6. Was the item(s) located in an area accessible to the public (e.g., sidewalk, front yard, parking lot)?
If YES, please contact the Laboratory before submission.
7. Was the item(s) left behind by the perpetrator?
8. Does the item(s) belong to the victim?
9. Was the item(s) present at the crime scene before the crime was committed?
10. Has the item(s) ever been handled by someone other than the perpetrator (e.g., owner/victim)?
If YES, an elimination standard from this person must be submitted under the same DPS DR number.
11. Was the item(s) taken directly from the suspect or from something belonging to the suspect (e.g., backpack, car, etc.)?
If YES, please contact the Laboratory before submission.
12. If a sexual assault, does the victim have a consensual sex partner within 120 hours of the alleged assault?
If YES, an elimination standard from this person must be submitted under the same DPS DR number.
13. Is there any additional important information that the laboratory needs to know (e.g., victim & perpetrator live together)?
Arizona Department of Public Safety Crime Laboratory
DNA Evidence Submission Supplement
Answer the questions below and attach to request form or email to the appropriate lab handling your request.
Lack of information or incomplete answers will result in the delay of analysis.
PHOENIX: crcl_dna@azdps.gov TUCSON: srcl_dna@azdps.gov FLAGSTAFF: nrcl_dna@azdps.gov
All questions must be answered.
If there is one or more perpetrators in the case or if anyone other than the perpetrator (victim/owner/residents) has touched the
evidence item ever, elimination standards from this (these) individual(s) must be obtained and SUBMITTED IN A SEPARATE
ENVELOPE UNDER THE SAME DPS DR NUMBER.
