Authorization to Alter Evidence

AUTHORIZATION TO ALTER FIRE EVIDENCE
CASE/CLAIM #:*
POLICY #:
CARRIER/DEPARTMENT:
CASE NAME/INSURED:*
LOSS LOCATION:
INCIDENT DATE:

MonthDayYear
INVESTIGATOR CASE #:
AFA CASE #:
AUTHORIZING PERSON:*
CARRIER/AGENCY:*
ACKNOWLEDGEMENT I, {authorizingPerson} of {carrieragency14}, am authorized to permit Analytical Forensic Associates to cut or otherwise alter evidence from the above reference case in order to place in an appropriate container for the recovery of ignitable liquid residues. I understand that the evidence will be forever changed from its original shape or form as was initially submitted to Analytical Forensic Associates.
SIGNED (or you may digitally sign below):

Clear
DIGITALLY SIGNED:
By typing my name above, I am electronically signing this Authorization to Destroy Evidence for this case.
DATE:*

MonthDayYear
ADDRESS:
CITY:
STATE/PROVINCE:
ZIP/POSTAL CODE:
PHONE:*
FAX:
EMAIL:*
Should be Empty:

AUTHORIZATION TO ALTER FIRE EVIDENCE