EFTA00132004



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 Indent |
| □ Req. Charging □ Freeze □ Refrigerate | Printed Name/Agency: |
| □ Biohazard | Reason: Initial Collection |
| □ Other | Collecte1 By: Agency: |

### Reliable Information

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/12/19 10:00AM | Signature: 8/12/15 10:00AM |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |

### Reliquished Information

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/15 10:20AM | Signature: 8/15/15 10:20AM |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |

### Reliquished Custody

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

### Reliquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/15 30:00PM | Signature: 9/25/22 32:00PM |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |

### Reliquished 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: |
| :--- |
| Signature: |
| Date: |

ATF Trace Form Completed:

NCIC: □

Case ID: 90A-NY-3151227

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



EFTA00132005


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>5/10/20<br>11:50am</td><td>Signature:<br>Printed Name<br>Reason:</td><td>5/10/20<br>11:50am</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>5/10/20<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: 904- M-3151227 1B: 0 Barcode: E6516202

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