# PALM BEACH POLICE DEPARTMENT
PROPERTY RECEIPT

PBPD Form #52

CONTRIBUTOR'S COPY

[ ] PROPERTY [ ] FOUND [ ] DECEASED (Probated) [ ] PERSONAL [ ] CONFISCATED [ ] DESTROY
[ ] EVIDENCE [ ] TRIAL [ ] LABORATORY [ ] STOLEN/RECOVERED [ ] OTHER

INCIDENT/CITATION NUMBER: 05-368
DATE/TIME RECOVERED: 10/8/21
PROPERTY NUMBER (Leave Blank): <empty>
BIN NUMBER (Leave Blank): <empty>

ADDRESS WHERE PROPERTY IMPOUNDED: ██████████ WEST PALM BEACH FL 33011

DISCOVERED BY / D.O.B.: <empty>
ADDRESS:
Street: <empty>
City: <empty>
Zip: <empty>
PHONE NUMBER: <empty>

OWNER'S NAME / D.O.B.: Palm Beach Police Dep
ADDRESS:
Street: ██████████
City: West Palm Beach
Zip: 33401
PHONE NUMBER: ██████████

SUSPECT'S NAME / D.O.B.: <empty>
ADDRESS:
Street: <empty>
City: <empty>
Zip: <empty>
PHONE NUMBER: <empty>

ADDT'NL. SUSPECT / D.O.B.: <empty>
ADDRESS:
Street: <empty>
City: <empty>
Zip: <empty>
PHONE NUMBER: <empty>

SPECIAL INSTRUCTIONS: <empty>

FOUND PROPERTY CLAIM [ ]
90 DAYS NOT CLAIM [ ]

# PALM BEACH POLICE DEPARTMENT
PROPERTY RECEIPT (cont.)

<table><tr><th>ITEM #</th><th>QUANTITY</th><th>VALUE</th><th></th><th>DESCRIPTION</th></tr><tr><td></td><td></td><td></td><td>Bon</td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td>TOTAL PACKAGE WEIGHT</td><td></td></tr></table>

I hereby acknowledge that the above list represents all property taken from me and that I have received a copy of this receipt.

110/2/21

I hereby acknowledge that the above list represents all property impounded by me in the official performance of my duty as a police officer. 756

# PALM BEACH POLICE DEPARTMENT
PROPERTY RECEIPT (cont.)

SIGNATURE

DATE

SIGNATURE ID# UNIT

<table><tr><th>RECEIVED BY</th><th>REASON</th><th>DATE/TIME RECEIVED</th></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr></table>

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