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

TEXAS DEPARTMENT OF PUBLIC SAFETY

CRIME LABORATORY

Seized Drugs Overdose Case Submission Form

LAB-217 Rev.00 (05/2023) p.2 Issued by: SQM

**PLEASE TYPE INFORMATION**

New Service Request

Additional Evidence	Resubmission	Corrected Copy

DPS Lab Case # (if known)
Submission Information
Agency
Agency Case #
Offense	18OD – Overdose (death or serious bodily injury)
Offense Date
Offense County
Agency Contact Information
Submitting Agent

Title / Badge #
Full Name
Agency Address	City, State, Zip
Mark if new address
Business Email	Phone	Fax
Contact Info for Additional Report Distribution:
Case Agent (if different from Submitting Agent)
Title / Badge #
Full Name
Business Email	Phone	Fax

Prosecutor has reviewed this evidence?	Seeking Federal or State prosecution?	Has a defendant been indicted?	Date testing must be complete (if known)

Individual (S = Suspect, V = Victim)

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

List any suspected drugs:

Description of Evidence Submitted	Note: All weights must include packaging; estimate large quantities using weight	2nd page not used

Agency Item #	Brief Description of Evidence	Evidence Type	Source	Weight	Quantity

Agency Item #	Brief Description of Evidence	Evidence Type	Source	Weight	Quantity