Evidence / Exhibit Receipt

Case Number:

Date Items Seized:

Exhibit(s) collected by: Investigator

Date (seized/located) Time

Location (seized/located)

Individual or Organisation Items Seized from

Item Quantity Description

The above items have been seized as evidence by Independent Policing Oversight
Authority investigators pursuant to Part II, Section 7 (1) (a) (iii) of the Independent
Policing Oversight Authority Act 2010.

Seized by (Investigator Signature): Date:

I acknowledge that the above listed items were seized from me or from premises
under my control.

Signature: Date

IPOA404