This government document is issued by State Police for use in West Virginia
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https://www.google.com/url?client=internal-element-cse&cx=007317577438028001491:cc_mlqhhaxa&q=https://www.wvsp.gov/departments/laboratory/Documents/Family%2520Reference%2520Sample%2520Submission%2520Form%25206-23-22.pdf&sa=U&ved=2ahUKEwj9nv2k6tuMAxWo1wIHHYFIAVoQFnoECAYQAQ&usg=AOvVaw2xJzMYQgEASWP4DClFj_Go