State of Minnesota

Department of Law and Public Safety

Division of  State Police

Request for Examination of Evidence

Crime:                                                   In the County of:                     

Lab No:                                                  Submitting Agency:

Victim:

Suspect:

Forward Replies to:

Investigated by:                                              Delivered by:

Brief History of Case:

Examinations Requested:

1.

2.

3.

4.

5.

List of Specimens:

1.

2.

3.

4.

5.

Note:  Photos of above scene to be forwarded.