Control No.

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FORM C (Rule 6)

CERTIFICATE OF PROOF OF

CHAIN OF PHYSICAL CUSTODY OR CONTROL

(Subsequent Change of Custody)

This is to certify that I, , am employed by as and that on

I received from	of the following substance(s) of container(s) which were originally seized by :

(Describe substance or container with sufficient particularity to distinguish it.)

On , I made delivery of the above described substance(s) or container(s) of

in substantially the same condition as when I received it.

(Signature)

(Place):

(Date):

Sworn before me this
day of	,	2
Notary Public for South Carolina
My Commission expires

Control No

cyon

2003-02-26

South Carolina Judicial Department