y6)44 (Rev. 4-I I-0))
File Number
Field Office Acquiring Evidence ^eh
Serial ti of Originating Document C(
Date Received
From
(Name o(Conuitmnornnecranna)
(Address)
(City and Slate)
By
To De Returned ❑ Yes 131 No
Receipt Given ❑ Yes El No
Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e)
Federal Rules of Criminal Procedure
❑ Yes 131 No
Federal Taxpayer Information (Fru
❑ Yes 0 No
Title:
Reference:
(Conlin...take, Encbstag Mastnal)
Description: Ef Original notes re interview of
3501226-028
CONFIDENTIAL Page I of I
EFTA_00075819
EFTA01248920