Submission Method In Person Drop Box Mail/Certified
Other
DPS Laboratory Use Only DPS Laboratory Case #
Complete the following for in person submissions only:
Printed Name (of submitting individual)	Agency
Signature	Date

New Service Request For Destruction

Additional Evidence For Destruction	Corrected Copy

DPS Lab Case # (if known)

Submission Information

Agency
Agency Case #
Offense	18D – None – Destruction Only
Offense Date
Offense County

Agency Contact Information

Title / Badge #
Full Name
Agency Address	City, State, Zip
Mark if new address
Business Email	Phone	Fax

Individual (S = Suspect, V = Victim)

Name (Last, First, Middle, Suffix)	S / V	Race	Sex	DOB

Description of Evidence Submitted

Agency Item #	Brief Description of Evidence	Evidence Type	Source	Weight	Quantity	LAB USE ONLY
Weight	Quantity
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Evidence Condition: Dried Undried (Wet)	Note: All weights must include packaging, estimate large quantities using weight

Description of Evidence Submitted

Agency Item #	Brief Description of Evidence	Evidence Type	Source	Weight	Quantity	LAB USE ONLY
Weight	Quantity
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Powder Liquid Tablet(s) Capsule(s) Plant(s) Edible(s) Paraphernalia
Evidence Condition: Dried Undried (Wet)	Note: All weights must include packaging, estimate large quantities using weight