WE MOVED TO A NEW ADDRESS AT 12 Nevada Street, Suite C., Redlands, CA 92373 Case Submission Agency Case Number(Required) Submitting Agency(Required) Contact Name(Required) Current Date(Required) MM slash DD slash YYYY Select all that apply(Required) Initial Evidence Submission Additional Submission CODIS Request Authorized Point(s) of ContactName(Required) First Last Agency Phone(Required)FaxEmail(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is there another contact you'd like to add?(Required) Yes No 2nd Point of Contact InfoName First Last Agency PhoneFaxEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mailing AddressName(Required) First Last Agency Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is the mailing and billing address the same?(Required) Yes No Is the mailing address the same as the Evidence return address?(Required) Yes No Billing AddressName First Last Agency Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Evidence return addressName First Last Agency Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Case infoSuspect Name(Required) Victim Name(Required) Charged Offense(Required) Case Summary(Required)Evidence ListITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYITEM # BRIEF DESCRIPTION OF EVIDENCE Consumption PermittedCONSUMPTION PERMITTEDYesNoTESTING REQUESTEDTESTING REQUESTEDMVAC DNA COLLECTIONDNA TESTING - GLOBALFILERDNA TESTING - Y FILER PLUS(MALE ONLY)DNA QUANTIFICATION ONLYBODY FLUID IDENTIFICATIONSPERM SEARCH - MICRO EXAMSEMINAL FLUID CONFIRMATIONHUMAN BLOOD CONFIRMATIONOTHER - PLEASE SPECIFYAdditional CommentsI HEREBY CERTIFY THAT ALL INFORMATION PROVIDED ON THIS CASE SUBMISSION FORM IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE PURE GOLD FORENSICS, INC. TO CONDUCT THE REQUESTED TESTING ON THE SAMPLES LISTED ABOVE IN ACCORDANCE WITH ITS STANDARD PROCEDURES, TERMS AND CONDITIONS. I UNDERSTAND THAT I WILL BE CHARGED ACCORDING TO THE APPLICABLE FEE SCHEDULE OR CONTRACT.Authorized Signatory's Name (print) First Last Signature(Required) Reset signature Signature locked. Reset to sign again APAPPX20 v0324Effective Date: 3/4/24 TV
