ORDER FOR WITHDRAWAL OF BLOOD SAMPLES



, ( Circuit Court ( General District Court Case No(s).:

, ( Juvenile and Domestic Relations District Court

← Commonwealth of Virginia

← In re/v.

(FULL NAME)

Complete line below only if ordered to report and not remanded into custody

M F

D.O.B. SOCIAL SECURITY NUMBER RACE GENDER

ORDER FOR WITHDRAWAL OF BLOOD SAMPLES AND/OR FOR PREPARATION

OF REPORTS TO CENTRAL CRIMINAL RECORDS EXCHANGE

The defendant is

|( ordered to report to__________________________________________________________________________________ |

|(AGENCY/FACILITY) |

|on __________________________ at ______________________________(AM) (PM) with the following proof of identity: |

|( Virginia driver’s license ( _______________________________________________________________ |

|( remanded to the custody of __________________________________________________________________________ |

for the purposes checked below:

← withdrawal of blood sample(s) for

← DNA (deoxyribonucleic acid) analysis to be sent to the Division of Forensic Science within 15 days after withdrawal §§ 19.2-310.2 and 19.2-310.3

← Testing for infection with HIV (human immunodeficiency virus), §§ 18.2-62 or 18.2-346.1

← Fingerprinting and obtaining data for the preparation of a report to the Central Criminal Records Exchange, §§ 19.2-390

The defendant is Ordered to cooperate fully and promptly in providing information and permitting fingerprinting and/or withdrawal of blood samples as required by this Order. Upon completion of these procedure(s), the defendant shall be released but shall be subject to the terms and conditions of any other order(s) governing the defendant’s release/incarceration.

Complete only if remanded into custody:

After completion of the above-described requirements, the defendant shall:

← remain in custody to serve time.

← be released but required to return to custody on for deferred execution of sentence.

← be released on probation or on suspended execution of sentence.

← be released.

DATE ENTERED JUDGE

| | |

|To Agency/Facility: | |

|Complete and return to the above-named court. | |

|Fingerprinting/Blood Withdrawal completed as ordered. | |

|Defendant failed to appear as ordered. | |

|Defendant failed to provide required proof of identity. |I acknowledge receipt of this Order. |

|___________________ ___________________________ |______________________________________________ |

|DATE SIGNATURE AND TITLE |DEFENDANT |

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