Dd Form 2922 - Forensic Laboratory Examination Request Page 2

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12. EVIDENCE SUBMITTED (Continued)
b. DESCRIPTION OF EXHIBIT
a. EXHIBIT
13. EXAMINATION(S) REQUESTED (Briefly furnish any information or instructions that might assist the laboratory in examining the evidence)
14.a. INVESTIGATOR AND ALTERNATE POC
b. TELEPHONE
:
(Primary/Alt)
(Typed or Printed) (Mandatory Information)
c. DSN
:
(Primary/Alt)
d. Fax:
e. E-Mail:
15. I CERTIFY EVIDENCE HAS NOT BEEN SUBMITTED TO ANOTHER LABORATORY FOR THE SAME EXAMINATION
b. TYPED/PRINTED NAME OF REQUESTOR
a. DATE
d. TELEPHONE
:
(Primary/Alt)
e. DSN
:
(Primary/Alt)
c. SIGNATURE
f. Fax:
g. E-Mail:
16. LAB USE ONLY
LAB CASE #
DD FORM 2922 (BACK), JUL 2006
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