EFTA00132007



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

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

**Item # 9**

#### Special Handling Instructions

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

### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/18/19 | Signature: 8/12/19 |
| Printed Name: 10:00am | Printed Name: 10:00am |
| Reason: TO CART | Reason: CART |
| Relinquished Custody | Accepted Custody |
| Signature: 8/15/19 | Signature: 8/15/19 |
| Printed Name: 10:20am | Printed Name: 10:20am |
| Reason: TO CIA | Reason: RECEIVEN |

### Relinquished Custody

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

### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/16/19 | Signature: 91/25/20 |
| Printed Name: 3:00pm | Printed Name: 3:00pm |
| Reason: Received from CRF |

### 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):

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

ATF Trace Form Completed: ☐ NCIC: ☐

Case ID: 90A-NY-3151227

Barcode: E6516202

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

EFTA00132008

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 Reason:</td><td>5/12/14 11:50am</td><td>Signature: Printed Name Reason:</td><td>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: Printed Name Reason:</td><td>5/3/14 11:50am</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>

Case ID: 40A-M-3151227 IB: 9 Barcode: E6S16202

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