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FORM B (Rule 6)
CERTIFICATE OF PROOF OF CHAIN OF PHYSICAL CUSTODY OR CONTROL (Initial Custody) This is to certify that I
(Name) (Name of Agency or Department)

am employed by and that on, 2 , I seized from
(Name)

pursuant to
(State Whether Subject to a Warrant, Lawful Arrest or Otherwise)

at or near
(Place Where Seized)

the following substance(s) of container(s):
(Describe substance or container with sufficient particularity to distinguish it.)

On container(s) to

2
(Name)

, I made delivery of the above described substance(s) or of in substantially the same condition

(Law Enforcement Agency)

as when I received it.
(Signature)

(Place): (Date): Sworn before me this day of Notary Public for South Carolina My Commission expires , 2