EFTA00131992



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

| Evidence Type: | General | Drugs | Firearms/Wesipon | Item # |
| :--- | :--- | :--- | :--- | :--- |
| Digital | Valuables | Firearms/Other | | |

**Special Handling Instructions**

| | Initial Receipt | Date and Time |
| :--- | :--- | :--- |
| □ HAZMAT | Latents | Signature of Seizing Individual: |
| □ Req. Charging | Freeze | Printed Name/Agency: |
| □ Biohazard | Refrigerate | Reason: Initial Collection |
| □ Other | | Collected By: Agency: FBI |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/12/19 | Signature: 8/12/19 |
| Printed Name/Agency: | 10:20am | Printed Name/Agency: 10:20am |
| Reason: TO CART | Reason: | Reason: RECEIVEN |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/15/15 | Signature: 8/15/15 |
| Printed Name/Agency: | 10:20am | Printed Name/Agency: 10:20am |
| Reason: TO CLA | Reason: RECEIVEN |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/16/17 | Signature: 8/16/17 |
| Printed Name/Agency: | 2:00pm | Printed Name/Agency: 2:00pm |
| Reason: TRANSFER | Reason: ACCEPTED |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/17/14 | Signature: 9/12/19 |
| Printed Name/Agency: | 3:10pm | Printed Name/Agency: 3:10pm |
| Reason: Transfer to OTD | Reason: RECEIVEN |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | | Signature: |
| Printed Name/Agency: | | Printed Name/Agency: |
| Reason: | | Reason: |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | | Signature: |
| Printed Name/Agency: | | Printed Name/Agency: |
| Reason: | | Reason: |

**Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):**

- Printed Name:
- Signature:
- Date:

This form is incomplete without reference to the FD-1087.

EFTA00131993

EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th>Relinquished Custody</th><th>Date and Time</th><th>Accepted Custody</th><th>Date and Time</th></tr></thead><tbody><tr><td>Signature: Printed Name/Agency: Reason:</td><td>5/21/20 11:00am</td><td>Signature: Printed Name: Reason:</td><td>5/31/20 11:00am</td></tr><tr><td>Relinquished Custody:</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency: Reason:</td><td>5/31/20 11:00am</td><td>Signature: Printed Name/Agency: Reason:</td><td></td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency: Reason:</td><td rowspan="2">Date and Time</td><td>Signature: Printed Name/Agency: Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Accepted Custody

Case ID: 90A-M-3151227 IB: 4 Barcode: E6516297

This form is incomplete without reference to the FD-1087.