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AFFIDAVIT
(RE-TABS)
If
a police officer uses two re-tabs on the back of the sample collection
card, 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 (re-tabs)
- 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) using the supplies provided in a single operational DNA
Data
Bank sampling kit.
- 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) placed two re-tabs on the back of the sample collection
card (3800) and the fingerprints on these two re-tabs belong
to _____________________ _____________(state offender's name).
- 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) or on the back of the sample collection card (3800)
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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