Medical Examiner Personal Effects/Evidence Release Form
The Delaware County Medical Examiners Office
Decedent Name
*
Date of Death
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Medical Examiner Case #
Police Case #
*
Rank of Officer
Officer / Detective Name
First Name
Last Name
Email
example@example.com
Law Enforcement Agency
Please Select
Delaware County CID
Pennsylvania State Police
Aldan Borough PD
Aston Twp PD
Bethel Twp PD
Brookhaven Borough PD
Chadds Ford Twp PD
Chester City PD
Chester Heights Borough PD
Chester Twp PD
Clifton Heights Borough PD
Collingdale Borough PD
Colwyn Borough PD
Concord Twp PD
Darby Borough PD
Darby Twp PD
East Lansdowne Borough PD
Eddystone Borough PD
Edgemont Twp PD
Folcroft Borough PD
Glenolden Borough PD
Haverford Twp PD
Lansdowne Borough
Lower Chischester Twp PD
Marcus Hook Borough PD
Marple Twp PD
Media Borough PD
Millbourne Borough PD
Morton Borough PD
Nether Providence Twp PD
Newtown Twp PD
Norwood Borough PD
Parkside Borough PD
Prospect Park Borough PD
Radnor Twp PD
Ridley Park Borough PD
Ridley Twp PD
Rutledge Borough PD
Sharon Hill Borough PD
Springfield Twp. PD
Swarthmore Borough PD
Tinicum Twp. PD
Trainer Borough PD
Upland Borough PD
Upper Chichester Twp. PD
Upper Darby Twp PD
Upper Providence Twp PD
Yeadon Borough PD
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 kin
I 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
*
Cards
Currency
Jewelry
Wallet/Purse
Key
Item(s) to be retrieved by agency
*
GSR Kit
Fingernail
Fingerprint
Hair
Ballistics
Rape Kits
Electronic Device
Wallet/Purse
Clothes
Keys
Swaps with Biological Samples
Ligature
Prescription Medication
Non-Human Bones
Item(s) to be relinquished by agency
*
GSR Kit
Fingernail
Fingerprint
Hair
Ballistics
Rape Kits
Electronic Device
Wallet/Purse
Clothes
Keys
Swaps with Biological Samples
Ligature
Prescription Medication
Non-Human Bones
Other
Please select one
*
I agree to pick up personal effects/evidence for the above named decedent at the DCOME 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
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: