EFTA00131998



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

### Evidence Type:
- General
- Drugs
- Firearms/Weapon
- Digital
- Valuables
- Firearms/Other

**Item # 6**

## Special Handling Instructions

| | Initial Receipt |
| :--- | :--- |
| □ HAZMAT □ Latents □ FGJ | Signature of Seizing |
| □ Req. Charging □ Freeze □ Refrigerate | Printed Name/Agency |
| □ Biohazard | Reason: Initial Collection |
| □ Other | Collected B | Agency: FBI |

### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/12/19 | Signature: |
| Printed N: 10:00am | Printed Name: Reason: CAST |
| Reason: TO CART | Reason: CAST |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 8/15/19 | Signature: |
| Printed N: 10:20am | Printed Name: Reason: RECEIVED |
| Reason: TO CA | Reason: RECEIVED |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 8/15/19 | Signature: |
| Printed N: 2:00pm | Printed Name: Reason: ACCEPTED |
| Reason: TANSPER | Reason: ACCEPTED |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 8/15/19 | Signature: |
| Printed N: 3:00pm | Printed Name: Reason: RECEIVED FROM CITY |
| Reason: TRANSFER OTD | Reason: RECEIVED FROM CITY |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: | Signature: |
| Printed Name/Agency: | Printed Name/Agency: Reason: |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: | Signature: |
| Printed Name/Agency: | Printed Name/Agency: Reason: |
| Reason: | Reason: |

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

| Printed Name: |
| :--- |
| Signature: |
| Date: |

ATF Trace Form Completed:

NCIC: □

Case ID: 90A-NY-3151227

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

EFTA00131999

EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th>Relinquished Custody</th><th>Date and Time</th><th>Accepted</th><th>Date and Time</th></tr></thead><tbody><tr><td>Signature:<br>Printed Name<br>Reason:</td><td>5/14/09 11:30am</td><td>Signature:<br>Printed Name<br>Reason:</td><td>5/14/09 11:30am</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:<br>Printed Name<br>Reason:</td><td>5/13/09 11:30am</td><td>Signature:<br>Printed Name/Agency:<br>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:<br>Printed Name/Agency:<br>Reason:</td><td>

Case ID: 40A-M-3151227 IB: 6 Barcode: E6516299

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