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PRESIDENT’S
DNA
Print Form
INITIATIVE
Advancing Justice Through DNA Technology
Unidentified Human Remains Submission Form
Submitting Agency Information
Submitting Agency: ____________________________________________
Agency Case No.: __________________________
Address: ______________________________________________________
ME/Coroner No.: __________________________
(If different from above)
______________________________________________________________
NCIC No.: ________________________________
______________________________________________________________
CODIS Spec ID No.: ________________________
Contact Name: ________________________________ Phone No.: ____________________ Fax No.: __________________
E-mail Address: ______________________________________________________________________________________________
Submitting agency’s shipping account (for return shipment of remains unless other arrangements have been made)
Shipping Company: ____________________________________________
Account Number: ______________________________________________
Evidence Submitted
LAB NO.
ITEM NO.
QUANTITY
DESCRIPTION
Reserved for
database use
Chain of Custody (Required)
Sign when releasing evidence
Released by: __________________________________________
Signature
______________________________ ____________________
Printed Name
Date & Time Released
Released to: __________________________________________________ ____________________________________________
Courier
Received by: __________________________________________
Signature
Tracking Number
______________________________ ____________________
Printed Name
Date & Time Received
Lab Case No:
________________________
Additional Required Information
The information found in Medical Examiner/Forensic Pathology, Forensic Anthropologist
and Investigator reports is often critical in the CODIS identification process. Using this data,
potential match candidates may be included or excluded, reducing the candidate field to the
most likely match(es). For skeletal cases, a forensic anthropological analysis is recommended
and can be provided by the University of North Texas Center for Human Identification at
no cost.
Please indicate the reports included with this submission:
Medical Examiner/Forensic Pathologist
Forensic Anthropologist
Investigator (Sheriff, Police Department, etc.)
I
I
I
Medical Examiner and/or Forensic Anthropologist Reports
Please provide a copy of a forensic anthropologist’s and/or a medical examiner’s report
with this completed form. It is very important that we receive copies of these reports. If there
are anthropological and pathology reports, please submit both reports. If you have any
questions regarding the submission of these reports, please contact our evidence custodian
at 817-735-0624 or 800-763-3147.
If you need a forensic anthropologist’s report, one can be provided for you at no cost to your
agency. Please refer to the section of the instruction booklet titled, Submission of Unidentified
Human Remains for Anthropological and DNA Analysis. If you have further questions, please
call the Laboratory of Forensic Anthropology at 940-565-4335 or 800-279-1339.
Investigator Reports
Additional information used to filter CODIS associations can often be found in the investigative
agency’s report. Please include a copy of the originating agency’s report.
NOTE: These reports are treated as confidential documents and will not be released.
Unidentified Human Remains Related Information
Leave fields blank for sex, age, race and stature if that information has not been determined.
Date Remains Found (MM/DD/YY): ______________________________
Approximate Age: __________________________
Location Where Remains Found: ______________________________________________________________________________
Sex of Remains:
Male I
Female I
Approximate Height: ______________ Race: ______________________
Physical Identifiers (scars, tattoos, medical devices, etc.): __________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Collecting Agency Information
Complete this section if the submitting agency is not the agency which recovered the remains OR
if there are multiple agency case numbers.
Agency: ______________________________________________________
Agency Case Number: ______________________
Address: ______________________________________________________
______________________________________________________________
______________________________________________________________
Contact Name: ________________________________ Phone No.: ____________________ Fax No.: __________________
E-mail Address: ______________________________________________________________________________________________
Potential Match Information
Complete this section if you have any information concerning the possible identity of the unidentified remains.
Investigating Agency: __________________________________________
Agency Case Number: ______________________
(for the missing persons case)
Address: ______________________________________________________
NCIC No.: ________________________________
______________________________________________________________
______________________________________________________________
Contact Name: ________________________________ Phone No.: ____________________ Fax No.: __________________
E-mail Address: ______________________________________________________________________________________________
Have reference samples for the missing person been previously submitted to CODIS?
Yes I
Are reference samples being submitted at the same time as this unidentified remains sample?
No I
Yes I
No I
Submission of Unidentified Human Remains for Anthropological Analysis
NOTE: Complete this page when submitting skeletal remains for anthropological analysis in addition to DNA database
submission. A separate forensic anthropology report will be returned to your office with the remains. Please review the
Submission of Unidentified Human Remains to the Laboratory of Forensic Anthropology sheet on the last page of the
information packet.
Description of remains submitted:
Description of recovery context (burial, surface scatter, submerged, etc.):
Description of the recovery environment (near water, desert, brush, etc.):
Was any clothing present/recovered at the scene?
Additional items submitted:
Scene Photographs
Medical Examiner Report
Police Report
Dental reports/charting
I
I
I
I
Yes I
No I
Clothing
Insect material
Prior Anthropological Report
Other (describe below)
Very Important
Has any skeletal material been removed for other DNA analysis?
If yes, describe the material removed and where it was sent:
Has any skeletal material been retained by the submitting agency?
If yes, describe the material retained and not submitted:
UHR SUB FORM - REV NOV 2008
Yes I
Yes I
I
I
I
I
No I
No I
GA08-1550 12-2007