Medical Examiner Personal Effects/Evidence Release Form

Medical Examiner Personal Effects/Evidence Release Form

The Delaware County Medical Examiners Office
Decedent Name*
Date of Death*

MonthDayYear
Date
Medical Examiner Case #
Police Case #*
I, Officer's Name* Badge #*, lawfully state that I am employed by * as a Title
Please select one*

I attest that the Personal Effects will be returned to the family hold no evidentiary value to this investigation, and can be picked up by family or next of kinI attest that this case is still under investigation and the above listed agency will retrieve the below listed items.I attest that the clothing pertaining to this case, is necessary for scientific testing, are not to be released, and will be picked up by my agency.I attest that the evidence pertaining to this case, no longer holds any evidentiary value, or is not necessary for scientific testing. This agency releases jurisdiction/authority of the item(s) to the Delaware County Medical Examiner’s Office, giving the right to destroy the listed item(s).
Item(s) to be picked up by family or next of kin*

CardsCurrencyJewelryWallet/PurseKey
Item(s) to be retrieved by agency*

GSR KitFingernailFingerprintHairBallisticsRape KitsElectronic DeviceWallet/PurseClothesKeysSwaps with Biological SamplesLigaturePrescription MedicationNon-Human Bones
Item(s) to be relinquished by agency*

GSR KitFingernailFingerprintHairBallisticsRape KitsElectronic DeviceWallet/PurseClothesKeysSwaps with Biological SamplesLigaturePrescription MedicationNon-Human BonesOther
Please select one*

I agree to pick up personal effects/evidence for the above named decedent at the DELCO MEO located at 340 N. Middletown Road Media PA Bldg. 19 (Fair Acres)I understand that the clothing pertaining to this case is a biohazard and contains samples that may have been degraded. I consent to the destruction of clothes pertaining to this case.
Please confirm*

I understand that any present or future claims to the personal effects/evidence of the above-named decedent have been waived and do not hold the Medical Examiner’s Office liable for its release or destruction
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: