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PRESIDENT’S

DNA

INITIATIVE

Advancing Justice Through DNA Technology

N A T I O N A L

M I S S I N G

P E R S O N S

P R O G R A M

Missing Person and Family Reference Sample Information Form

Name of Missing Person:

________________________________________ __________________________________ __________

Last

First

Missing Person’s Date of Birth: ______________________________

Age when missing: ____________ Approx. Height: ____________

I Female

I Male

I I

Sex of Missing Person:

Medical Anomalies (scars, marks, tattoos, medical devices, etc.):

I African-American

I I

Race:

________________________________________________________

I Asian

I I

________________________________________________________

I Caucasian

I I

I Yes

I No

I I

I Hispanic

I I

Are dental records available?

I Native American

I I

Date of Last Contact: ______________________________________

I Other (Please Specify) ______________________

I I

Location of Last Contact: ____________________________________

Family Member Providing

Reference Sample: ______________________________________________ __________________________________ __________

Last

First

I Female

I Male

I I

Sex of Family Member:

Relationship of Family Member

I African-American

I I

Race:

to Missing Person: ________________________________________

I I

I Asian

Note: The most useful family reference DNA samples are from close

I I

I Caucasian

blood relatives such as the missing persons biological mother, father,

I Hispanic

I I

children, brothers, or sisters (indicated on chart below with a star).

I Native American

However, close maternal relatives of the missing person allows for

I I

the analysis of both nuclear and mitochondrial DNA. If you have

I Other (Please Specify) ______________________

I I

any questions regarding the selection of family members for reference

sampling please call 1-800-763-3147.

CIRCLE BOX BELOW INDICATING RELATIONSHIP TO MISSING PERSON

Grandmother

Grandfather

Grandmother

Grandfather

Aunt

Uncle

Mother

Father

MISSING

Female Cousin

Male Cousin

Sister

Brother

Spouse

PERSON*

Second Cousin

Niece

Nephew

Daughter

Son

Great Niece

Great Nephew

Granddaughter

Grandson

Granddaughter

Grandson

Any of the shaded boxes represent a potential maternal relative. In addition, if the

missing person is female, any of her children are also considered a maternal relative.

* Primary Donor for nuclear DNA

Missing Person And Family Reference Sample Information Form - National Missing Persons Program

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