Cyber Crime Unit Submission Form

Tupelo Police Department

Criminal Investigation Division

Cyber Crime Unit Submission Form

Date

Submitting Agency(Required)

Tupelo Police Dept: CID

Outside Agency

Outside Agency Name(Required)

Law Enforcement Agency Name

Case Number(Required)

Your Dept. Case Number:

Lab Number

Cyber Crime Lab Use Only

BIOHAZZARD(Required)

YES

Bodily fluids or hazardous substance on device?

Offense(Required)

Submitting Officer(Required)

First Last

Officer Phone #(Required)

Victim Name

First Last

Suspect Name

First Last

Authorization(Required)

Search Warrant

Owner Consent

Attach SEARCH WARRANT or OWNER CONSENT FORM(Required)

Drop files here or

Accepted file types: pdf, jpg, gif, png, jpeg, Max. file size: 100 MB.

Special Instructions or Examination Needs

Device Information

Number of Items Being Submitted(Required)

Item (A)

Item (B)

Passcode (A)

Passcode (B)

Serial Number (A)

If Known

Serial Number (B)

If Known

IMEI: (A)

If Known

IMEI: (B)

If Known

Item (C)

Item (D)

Passcode (C)

Passcode (D)

Serial Number (C)

If Known

Serial Number (D)

If Known

IMEI: (C)

If Known

IMEI: (D)

If Known

Item (E)

Item (F)

Passcode (E)

Passcode (F)

Serial Number (E)

If Known

Serial Number (F)

If Known

IMEI: (E)

If Known

IMEI: (F)

If Known

Item (G)

Item (H)

Passcode (G)

Passcode (H)

Serial Number (G)

If Known

Serial Number (H)

If Known

IMEI: (G)

IMEI: (H)

Item (I)

Item (J)

Passcode (I)

Passcode (J)

Serial Number (I)

If Known

Serial Number (J)

If Known

IMEI: (I)

IMEI: (J)

Item (K)

Item (L)

Passcode (K)

Passcode (L)

Serial Number (K)

If Known

Serial Number (L)

If Known

IMEI: (K)

IMEI: (L)

Item (M)

Item (N)

Passcode (M)

Passcode (N)

Serial Number (M)

If Known

Serial Number (N)

If Known

IMEI: (M)

IMEI: (N)

CAPTCHA

Internal Use Only

This document is intended for internal use only. Any unauthorized distribution or sharing of this content is prohibited.

Internal Notes:

Device: ______________________ Model:______________________________ SN:__________________________________ IMEI:_________________________________ MSISDN:_____________________________ Accounts:________________________________________ EXAMINERS NOTES: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________