EFTA00132001



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 #**

#### Special Handling Instructions

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

#### Relinquished Custody

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

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/15 | Signature: 8/15/15 |
| Printed N: 10:20am | Printed N: 10:20am |
| Reason: TRANSFER | Reason: |

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/19 | Signature: 8/15/19 |
| Printed N: 20:00am | Printed N: 20:00am |
| Reason: TRANSFER | Reason: |

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/17 | Signature: 9/12/120 |
| Printed N: 3:00am | Printed N: 22:00am |
| Reason: TRANSFER | Reason: |

#### Relinquished Custody

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

#### Relinquished Custody

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

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

| | |
| :--- | :--- |
| Printed Name: | NCIC: |

ATF Trace Form Completed: □

Case ID: 90A-NY-3151227

Barcode: E6516200

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

EFTA00132002

## 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:<br>Printed Name<br>Reason:</td><td>9/12/20<br>11:50</td><td>Signature:<br>Printed Name<br>Reason:</td><td>3/6/20<br>11:50</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>6/3/20<br>11:50am</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: 90A-M-3151227 IB: 7 Barcode: E6526200

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