EFTA00129689







D-340 (Rev. 4-11-03)



File Number 72-mn-113327-1A9

Field Office Acquiring Evidence Miami / West Palm



Serial # of Originating Document .



Date Received 11/3/09

From

(Name of Contributor/Interviewee)

[Address]

(City and State)·

By ___ SA

To Be Returned □ Yes

Receipt Given □ Yes

Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e)

Federal Rules of Criminal Procedure



□ Yes



Federal Taxpayer Information (FTI)



□ No





□ Yes



No

Title:

Reference:

<font color="red">(Communication Enclosing Material)</font>

Description:



Original notes re interview of



1. bound black address book and.

2. stapled handwritten set of documents on yellow legal pad paper