EFTA00132031



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

Evidence Type: □ General □ Drugs □ Firearms/Weapon □ Digital □ Valuables □ Firearms/Other

Special Handling Instructions

□ HAZMAT □ Latents □ FGJ
□ Req. Charging □ Freeze □ Refrigerate
□ Biohazard
□ Other ___

Initial Receipt

Signature of S
Printed Name
Reason: Initial
Collected By:
Agency:

Date and Time

8/10/19
4:30am

Relinquished Custody

Date and Time

Accepted Custody

Date and Time

8/12/19
10:20am

Relinquished Custody

Date and Time

Accepted Custody

Date and Time

8/15/19
10:20am

Relinquished Custody

Date and Time

Accepted Custody

Date and Time

8/15/19
2:00am

Relinquished Custody

Date and Time

Accepted Custody

Date and Time

8/15/19
2:00am

Relinquished Custody

Date and Time

Accepted Custody

Date and Time

Signature:
Printed Name
Reason:

Signature:
Printed Name
Reason:

Signature:
Printed Name
Reason:

Signature:
Printed Name
Reason:

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

Printed Name:

Signature:

Date:

Case ID: 90A-NY-3151227

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

EFTA00132032

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>9/25/20 7:02 PM</td><td>Signature: Printed Name Reason:</td><td>9/25/20 7:02 PM</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>5/30/20 11:00 AM</td><td>Signature: Printed Name Reason:</td><td>5/30/20 11:00 AM</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>6/30/20 11:55 AM</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: 90A-M-3151227 IB: 17 Barcode: E6516210

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