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

am employed by as and that on ,2
(Date)

(Capacity of Employment)

I received
(Specify Whether by Mail or in Person)

from
(Name of Person)

of
(Law Enforcement Agency)


the following substance(s) of container(s) which were originally seized by

(Name of Person Making Original Seizure) (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