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y.222 . ; a EVIDENCE RECEIPT FORM - H (To be used in linu of cd; pondencs covering evidence su” .dsions to the S. F. P. 5.) Submitting agency__ Date Victim | _Accepted by__¢¢ 0 / a _3.hR.8. aed Offense : ee ae eS Place and date rr ar A Suspects BRIEF FACTS COVERING CASE: eee ee so repels trap Sear A et Cop':3 to Evidnance to be returned to_ grand jury, trial or ro3son why expeditious handling 1s necessary. Sp RR RA i ES ‘ EVIDENCE mere ‘ fa . | THIS SPACE FOR BLOCKING