EFTA00129937



O


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

File Number ___ 72-MM-113327-E2A 1A2

Field Office Acquiring Evidence ___ MM

Serial # of Originating Document ___

Date Received ___ 10/29/09

From ___

(Name of Contributor/Interviewee)

(City and State)

<table border="1"><tr><td>To Be Returned</td><td>Yes</td><td>No</td></tr><tr><td>Receipt Given</td><td>Yes</td><td>No</td></tr><tr><td colspan="3">Grand Jury Material - Disseminate Only Pursuant to Rule 6(c)</td></tr><tr><td colspan="3">Federal Rules of Criminal Procedure</td></tr><tr><td></td><td>Yes</td><td>No</td></tr><tr><td colspan="3">Federal Taxpayer Information(FTI)</td></tr><tr><td></td><td>Yes</td><td>No</td></tr></table>

Title:

Reference:

Description: Original notes to interview of FD-472, FD-473 + FD-473a