POLICIA NACIONAL DEL PERU

SUBGEN-REGPOL HUANUCO.
COMISARIA PNP CAYHUAYNA

ROTULO DE INDICIOS / EVIDENCIAS / ELEMENTOS RECOGIDOS

(EN CADENA DE CUSTODIA)
EN CADENA DE CUSTODIA
NÚMERO DE HALLAZGO : ______________________________________
CANTIDAD ___________________________ UNIDAD DE MEDIDA_______________________

DEPENDENCIA, UNIDAD, DIVISIÓN, QUE INTERVIENE:

_COMISARIA DE CAYHUAYNA____________________________________________________

LUGAR DE RECOLECCIÓN / DIRECCIÓN:

_CENTRO PENITENCIARIO DE POTRACANCHA______________________________________

DIA______MES__________AÑO__2019__ HORA_________: (0 - 24 HORAS)

DESCRIPCIÓN Y CONDICIÓN: ___________________________________________________

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TIPO DE EMBALAJE UTILIZADO:____________________________________________________
SERVIDOR QUE RECOLECTA EL BIEN

NOMBRE COMPLETO_____________________________________________________________
DNI _ ______________________________________________CIP Nº ____________________
CARGO_______________________________________________________________
FIRMA_______________________________________________________________________
FECHA DE EMBALAJE: DIA_ _MES_____AÑO__2019_HORA: ____________(0 – 24 HORAS)
OBSERACIONES : -------------------------------------------------------------------------------------------
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 ACTA DE LACRADO DE EVIDENCIAS

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