EFTA00131995

# FD-1004

Rev. 7-7-2016

FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

| Evidence Type: | General | Drugs | Firearms/Weapon | 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 |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/12/19 | Signature: 8/12/19 |
| Printed Name: | 10:00am | Printed Name: 10:00am |
| Reason: TO CART | | Reason: |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/15/19 | Signature: 8/15/19 |
| Printed Name: | 10:00am | Printed Name: 10:00am |
| Reason: TO CART | | Reason: |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/15/19 | Signature: 8/15/19 |
| Printed Name: | 2:00pm | Printed Name: 2:00pm |
| Reason: TRANSPER | Accepted | Reason: |

**Relinquished Custody**

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: | 8/15/19 | Signature: 8/15/19 |
| Printed Name: | 3:00pm | Printed Name: 3:00pm |
| Reason: TRANSPER | Reason: Received from ERF |

**Relinquished Custody**

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

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

Printed Name:

Signature:

Date:

Barcode: 6516198

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

EFTA00131996

EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th>Reinquished Custody</th><th>Date and Time</th><th>Accepted Custody</th><th>Date and Time</th></tr></thead><tbody><tr><td>Signature: Printed Name/Reason:</td><td>9/25/10 12:02</td><td>Signature: Printed Name/Reason:</td><td>9/25/10 12:02</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Reason:</td><td>5/18/11 11:04</td><td>Signature: Printed Name/Reason:</td><td>3/3/11 11:04</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Reason:</td><td>6/3/12 11:04</td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Reliquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td><td>Signature: Printed Name/Agency:</td><td rowspan="2"></td></tr><tr><td>Reason:</td><td>Reason:</td></tr></tbody></table>

Case ID: 40A-NM-31S1227 IB: 5 Barcode: E6S16198

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