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AFFIDAVIT
(BAR-CODES)
If
a peace officer submits a sample collection card with an altered
bar-code, and the judge refuses to grant the peace officer a Form
5.09 (Authorization for the taking of additional samples of bodily
substances for forensic DNA analysis), the officer shall provide
the National DNA Data Bank with the following:
Affidavit (Bar-Codes)
- I ____________________________(state
name, rank, badge no., police dept.) did take a biological sample
from _________________________ (state offender's name and D.O.B.)
on___________________________ (date and time).
- The biological
sample was taken from __________________________ (state offender's
name) as were his/her fingerprints on the Fingerprint Identification
Form (3801), and both were taken from the same offender on the
same occasion on____________________________ (date/time).
- I ________________________________(state
name) replaced the bar-code on the sample collection card with
a new bar-code matching the Fingerprint Identification Form
(3801).
- I ____________________________________
(state name) affirm that there is no possibility of having someone
else's biological sample on the sample collection card (3800)
and no one else's fingerprints on the Fingerprint Identification
Form (3801) and that both belong to ____________________________________(state
offender's name).
- I ________________________________(state
name) affirm that no other offender was sampled by me on this
same occasion ______________________________(date/time).
Officer's signature:_____________________ Date: ____________________
Officer's
name, rank:_____________________________________________
(please print)
Other
signature(s):_____________________ Date:____________________
(if applicable)
Other
name, title and rank: _______________________________________
(please print)
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