Fillable Sexual Assault Kit Supplemental Submission Form Version 2 (North Carolina Department of Justice)

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Sexual Assault Kit Supplemental Submission Form Version 2 (North Carolina Department of Justice)

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Sexual Assault Kit Supplemental Submission Form Version 2
North Carolina State Crime Laboratory Effective Date: 10/01/2020
Forensic Biology Section
Form approved for use by: Forensic Biology FSM
Page 1 of 2
STIMS #
PART A: TO BE COMPLETED BY LAW ENFORCEMENT AGENCY
(Please fill out as accurately as possible.)
By marking the check box, I acknowledge evidence was collected in connection with a criminal investigation and (select
one):
☐ I acknowledge there is clear and convincing evidence a crime DID NOT occur.
☐ I acknowledge that a crime DID occur AND/OR further investigation is required.
Has the crime already been prosecuted?
☐
Yes
☐
No
☐
Yes
☐
No
Does the submission include DNA standards from the victim?
☐
Yes
☐
No
Does the submission include DNA standards from the suspect?
☐
Yes
☐
No
☐
Yes
☐
No
Does the submission include DNA standards from all the consensual partners (within
120 hrs)?
☐
Yes
☐
No
☐
Yes
☐
No
FOR UNREPORTED OR ANONYMOUS KITS COLLECTED:
Under state law, if the victim consented to the collection of the sexual assault examination kit, but the victim has not consented
to participate in the criminal justice process by reporting the crime to a law enforcement agency send kits to the Department
of Public Safety Law Enforcement Support Services (LESS) warehouse for storage, instead of sending them to the Crime Lab.
N.C.G.S. 15A-266.5A.
FOR KITS COLLECTED ON OR PRIOR TO JANUARY 1, 2018 AND DETERMINED THROUGH MULTI-
DISCIPLINARY TEAM REVIEW AT A LAW ENFORCEMENT AGENCY TO BE “UNFOUNDED”:
For kits collected on or before January 1, 2018, the law enforcement agency may determine - after a comprehensive case
review and after complete review by the multi-disciplinary review team (MDT) established under the Survivor Act - that
based on clear and convincing evidence, a crime did not occur. Any such kits should not be sent to the Crime Lab, but instead
should be stored by the law enforcement agency along with a brief summary indicating the information and evidence
supporting the determination. If, after this determination, the law enforcement agency receives any information or evidence
that creates value for testing the kit, it shall send it to the Crime Lab as soon as possible. N.C.G.S. 15A-266.5A(d)(3)(b).
ATTENTION:
If at any time it is determined that a crime has not been committed for any kit previously submitted for testing, please
contact the State Crime Laboratory.
For Sexual Assault Kits collected on OR before January 1, 2018 for OUTSOURCING (please continue to Part B on page 2)
Sexual Assault Kit Supplemental Submission Form Version 2
North Carolina State Crime Laboratory Effective Date: 10/01/2020
Forensic Biology Section
Form approved for use by: Forensic Biology FSM
Page 2 of 2
PART B: TO BE COMPLETED BY LAW ENFORCEMENT AGENCY (For OUTSOURCING ONLY)
Requesting Officer:
(Print Name)
County of Offense:
Requesting Agency:
ORI #:
Agency Address, City and Zip:
Agency File #:
Type of Case:
Investigating Officer Name:
Date of Offense:
Contact Number and Email:
STIMS
Number:
VICTIM(S)
Race/Sex
DOB
SUSPECT(S)
Race/Sex
DOB
ID #
Has any evidence in this case been submitted to the NCSCL laboratory previously?
If yes, to which
section(s)?
Agency Item #
Description of Evidence
Exact Location Found
(Use names for body fluid/DNA Evidence)
NOTES: To Be Filled Out by North Carolina State Crime Laboratory Employees ONLY:
Please contact Forensic Biology at SAK@ncdoj.gov with any questions.
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Sexual Assault Kit Supplemental Submission Form Version 2 (North Carolina Department of Justice)

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Completed 28 January 2021

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