Firearms Reference Collection Receipt Version 3 North Carolina State Crime Laboratory Effective Date: 1/7/2019 Physical Evidence Section – Firearms Unit
FIREARMS REFERENCE COLLECTION RECEIPT
Submitting Agency: ______Date: ______
FR # Assigned: Keep Destroy Condition: G F P S/O (Sawed off)
Firearm Type: Pistol Revolver Derringer Rifle Shotgun Other
Semi Full Swing Break Pump/ Action: Pin Lever Bolt Air/CO2 Multi Barrel (____) Auto Auto Out Open Slide
Manufacturer: Model:
Caliber: Serial Number:
Safety Check upon Receipt: ☐ Safety Check on Entry to Collection: ☐
FR # Assigned: Keep Destroy Condition: G F P S/O (Sawed off)
Firearm Type: Pistol Revolver Derringer Rifle Shotgun Other
Semi Full Swing Break Pump/ Action: Pin Lever Bolt Air/CO2 Multi Barrel (____) Auto Auto Out Open Slide
Manufacturer: Model:
Caliber: Serial Number:
Safety Check upon Receipt: ☐ Safety Check on Entry to Collection: ☐
FR # Assigned: Keep Destroy Condition: G F P S/O (Sawed off)
Firearm Type: Pistol Revolver Derringer Rifle Shotgun Other
Semi Full Swing Break Pump/ Action: Pin Lever Bolt Air/CO2 Multi Barrel (____) Auto Auto Out Open Slide
Manufacturer: Model:
Caliber: Serial Number:
Safety Check upon Receipt: ☐ Safety Check on Entry to Collection: ☐
FR # Assigned: Keep Destroy Condition: G F P S/O (Sawed off)
Firearm Type: Pistol Revolver Derringer Rifle Shotgun Other
Semi Full Swing Break Pump/ Action: Pin Lever Bolt Air/CO2 Multi Barrel (____) Auto Auto Out Open Slide
Manufacturer: Model:
Caliber: Serial Number:
Safety Check upon Receipt: ☐ Safety Check on Entry to Collection: ☐
Form approved for use by: Page 1 of 1