FD-340 (Rev. 4.11.03)
File Number Tie- now- ibe 84,a.
Field Office Acquiring Evidence fil Pk.
Serial # of Originating Document
Date Received P4/p9/P-04) —>
From Vow cluArrer
(Name of Contributor/Interviewee)
(Address)
(City and State)
b6
By s-4. b7C
To Be Returned 0 Yes ErNo
Receipt Given El Yes GI, No
Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e)
Federal Rules of Criminal Procedure
❑ Yes Er No
Federal Taxpayer Information (1.11)
El Yes ra/ No
Title:
Reference:
(Commit:anon Enclosing Material)
Description: 0 Original notes re interview of
EFTA00791127