EFTA00129659¶
C 1A5¶
FD-340 (Rev. 4-11-03)¶
File Number 72-MM-113327 -1A8¶
Field Office Acquiring Evidence 11/18/2009¶
Serial # of Originating Document ___¶
Date Received ___¶
[Name of Contributor/Interviewee]¶
[Address]¶
By \underline{SA}¶
(City and State)¶
To Be Returned ☐ Yes ☐ No¶
Receipt Given □ Yes¶
□ No¶
Receipt Given¶
Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e)¶
Federal Rules of Criminal Procedure¶
| Yes | No |
| Federal Taxpayer Information (FTI) | |
| Yes | No |
Title:¶
Description: Original notes re interview of @ GJ Subpoena results for phone number¶