ATTORNEY LETTERHEAD

Date________

Forensic Laboratory

Attn: Blood Alcohol Division

James H. Hayes Safety Building

10 Hazen Drive, Concord, NH 03305

Re: _______________________

(subject’s name- Last, First, MI)

Tox Log# __________________

Dept Case#_____________________

To: Forensic Laboratories:

This firm represents (subject’s name) in connection with a sample analyzed by the Forensic Laboratory. I wish to have John J. Godfrey or Judith Rutty Godfrey of CG Labs, Inc., who are employed by my firm and are hereby authorized to pick up the remaining sample belonging to (subject’s name)

Sincerely

__________________

__________________

__________________

(Agency name, address, state, zip code)