EFTA00132022



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

| Special Handling Instructions | Initial Receipt |
| :--- | :--- |
| □ HAZMAT □ Latents □ FGJ | Signature of Seizing |
| □ Req. Charging □ Freeze □ Refigere | Printed Name/Agency |
| □ Biohazard | Reason: Initial Collection |
| □ Other | Collected By: Agency: FB1 |

#### Relinquished Custody

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

#### Relinquished Custody

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

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/19 2:00PM | Signature: Printed Name |
| Reason: TO CART | Reason: |

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/19 7:26PM | Signature: Printed Name |
| Reason: TO CART | Reason: |

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/19 7:26PM | Signature: Printed Name |
| Reason: TO CART | Reason: |

#### Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/15/19 7:26PM | Signature: Printed Name |
| Reason: TO CART | Reason: |

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

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

ATF Trace Form Completed:

NCIC: □

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

EFTA00132023

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>9/28/20<br>12:02</td><td>Signature:<br>Printed Name<br>Reason:</td><td>9/25/20<br>12:02</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>9/30/20<br>11:54am</td><td>Signature:<br>Printed Name<br>Reason:</td><td>9/30/20<br>11:54am</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 rowspan="2"></td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Reason:</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 rowspan="2"></td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Reason:</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 rowspan="2"></td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Reason:</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 rowspan="2"></td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Reason:</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 rowspan="2"></td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Reason:</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 rowspan="2"></td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2"></td></tr><tr><td>Relinquished Custody</td><td>Reason:</td></tr></tbody></table>

Case ID: 90A-M-3151227 1B: 14 Barcode: €6516207

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