Reference Sample Submission Form - Missing Persons Program - Oregon State Police Forensic Services Division

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O
S
P
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REGON
TATE
OLICE
ORENSIC
ERVICES
IVISION
M
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P
– R
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F
ISSING
ERSONS
ROGRAM
EFERENCE
AMPLE
UBMISSION
ORM
OSP Lab No.
Instructions: Complete each section as applicable (shaded area will be completed
by OSP). Note: All sections are required for submission. Sections 4, 5, and 6 must
be filled out for every family reference sample submitted. Omission of required
information may result in sample rejection.
1.
INVESTIGATING AGENCY
Agency:
Agency Case No:
Contact Name:
Phone No:
Contact Email:
NCIC No:
NamUs MP No:
NamUs UP No:
2.
MISSING PERSON INFORMATION
Name of Missing Person:
Last
First
Middle
Missing Person’s Date of Birth:
Age When Missing:
Sex of Missing Person: ☐Female ☐Male Eye Color:
Hair Color:
Approx. Weight:
Approx. Height:
Date of Last Contact:
City/County and State of Last Contact:
Are Dental Records Available? ☐Yes ☐No
Race: ☐African-American
Physical Identifiers (
):
scars, marks, tattoos, medical devices
☐Asian
☐Caucasian
☐Hispanic
☐Native American
☐Other (specify)
Is the missing person adopted? ☐Yes ☐No
Other relevant information:
3.
IMPORTANT DIRECT REFERENCE SAMPLE INFORMATION
The following sample types are acceptable as direct references: toothbrush, dentures, medically
obtained tissue or biopsies mounted on slides or embedded in paraffin. Should you wish to submit a
different sample type as a direct reference, contact the DNA Supervisor at 971-673-8230.
Originally Adopted:
Issuing Authority:
Revision #: 1
10/23/2017
Operations Manager
Effective Date: 10/23/2017
ALL COPIES OUTSIDE OF POLICY TECH ARE UNCONTROLLED
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