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.