ATLANTA POLICE DEPARTMENT

HIGH TECH CRIME UNIT

Computer Evidence Submission Form

Submitting Agency:	Investigating Officer: *	Rank

Address:	(city)	(state)	Office Number: *

Pager Number:	Cell Number:	Email:

Submitting Agency Case #	Date of Incident/Arrest *	County of Incident *

Delivering Officer *	Rank *	Office Number:

Evidence custodian	Evidence can be mailed to: *

Please check the box next to the correct victim type. If the victim is the State of Georgia, then you do not have to complete any other information in this box. Otherwise complete all other information.	Case Type *

(Check the primary charge
Victim: ( City of Atlanta ( Business ( Individual	( Death Investigation

( Assault

( Kidnapping

( Arson

( Criminal Damage to Property

( Burglary

( Fraud

( Telecommunications Fraud

( Theft

( Sexual Offenses

( Public Official Investigations

( Terrorist Acts/Threats

( Gambling

( Narcotic and Drug Investigations

( Child Abuse/Molestation

( Computer Intrusion

( Threats/Harassment/Stalking

( Extortion

( Identity Theft

( Software Piracy

Name: (First Middle Last)
SS/DL #: *	DOB: *	Race: *	Sex: *	Age:
Address: *	Phone:
Suspect: ( City of Atlanta ( Business ( Individual
Name: (First Middle Last)
SS/DL #: *	DOB: *	Race: *	Sex: *	Age:
Address: *	Phone:
Additional Information
1. What was the state of the computer at time of seizure?	( OFF	( ON
(If ON, please describe how the computer was shutdown below)
2. Was any attempt made to access the computer?	( OFF	( ON
Case Type *

(Check the primary charge

( Computer (Laptop or PC)

( Server / Raid Array

( Palm Pilot / Pocket PC

( Digital Camera

( Digital Compac Flash Card

( Memory Stick

( Thumb Drive

( Hard Drive Only

( Disks (Floppy, CD’s, etc.)

( Tapes / Data Cartage

( Cell Phone

( Cash Register

( Unknown

( Other
(If yes, please attach memo-describing actions taken)
3. Is there a search warrant or consent search for this evidence?	( Warrant	( Consent
(Please attach copy of search warrant, or copy of the consent waver)

LIST OF KEYWORDS TO BE SEARCHED

( LARGE NUMBERS OF HITS WILL RESULT IN INVESTOR BEING ASKED TO EXAMINE THEM )

Please make sure you include all power cables and charging cradles

APD 353 revised 3/19/04

Computer Evidence Submission Form

please send comments to
david.benton@gbi.state.ga.us

David Benton

2004-07-22

AJordan

Nancy Windom

Georgia Bureau of Investigation