Control No. Print All Information Except Where Signature Is Required FORM B (Rule 6) CERTIFICATE OF PROOF OF CHAIN OF PHYSICAL CUSTODY OR CONTROL (Initial Custody) This is to certify that I am employed by (Name) and that on, (Name of Agency or Department) 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 2 , I made delivery of the above described substance(s) or container(s) to of (Name) in substantially the same condition (Law Enforcement Agency) as when I received it. (Signature) (Place): (Date): Sworn before me this day of , 2 Notary Public for South Carolina My Commission expires