EFTA00132041 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 Seizing Person: Printed Name/Agency: - Reason: Initial Collection - Collected By: - Agency: FBI ## Reliquished Custody - Date and Time: 8/16/19 2:20pm - Accepted Custody: Signature: Printed Name Reason: Charge to OTD ## Reliquished Custody - Date and Time: 8/16/19 4:30pm - Accepted Custody: Signature: Printed Name Reason: Transport to OTD ## Reliquished Custody - Date and Time: 8/17/19 12:30pm - Accepted Custody: Signature: Printed Name Reason: Received from CRF ## Reliquished Custody - Date and Time: 8/17/19 12:30pm - Accepted Custody: Signature: Printed Name Reason: Received from CRF ## Reliquished Custody - Date and Time: 5/2/22 11:50pm - Accepted Custody: Signature: Printed Name Reason: Change out ## Reliquished Custody - Date and Time: 6/3/20 11:50pm - Accepted Custody: Signature: Printed Name/Agency Reason: --- **Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):** ATF Trace Form Completed: □ NCIC: □
Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT):ATF Trace Form Completed:□NCIC:□
Printed Name:
Signature:
Date:
Case ID: 90A-NY-3151227 IB: 23 This form is incomplete without reference to the FD-1087. EFTA00132042 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 InstructionsInitial ReceiptDate and Time
8/12/19
7:00pm
□ HAZMAT □ Latents □ FGJ
□ Req. Charging □ Freeze □ Refrigerate
□ Biohazard
□ Other ___		Signature of Seizing Indent
Printed Name:
Reason: Initial Collection
Collected By:
Agency: FBL
RelinquishedDate and TimeAccepted Custody
Signature:8/16/19Signature:
Printed N2:00 pmPrinted NReason: Charged In Office
Reason:Reason:
RelinquishedDate and TimeAccepted CustodyDate and Time
8/16/19
4:30 pm
Signature:8/16/19Signature:
Printed N14:30 pmPrinted NReason:
Reason:Reason:
RelinquishedDate and TimeAccepted CustodyDate and Time
8/17/19
12:30 pm
Signature:8/19/19Signature:
Printed N12:30 pmPrinted NReason: Paid for USTD
Reason:Reason:
Relinquished CustodyDate and TimeAccepted CustodyDate and Time
9/25/20
3:20 am
Signature:8/20/19Signature:
Printed N4:50 pmPrinted NReason: Received from CFF
Reason:Reason:
Relinquished CustodyDate and TimeAccepted CustodyDate and Time
5/24/20
11:00 am
Signature:5/24/20Signature:
Printed N11:00 pmPrinted NReason: Change act
Reason:Reason:
Relinquished CustodyDate and TimeAccepted CustodyDate and Time
Signature:5/23/20Signature:
Printed N11:00 pmPrinted Name/Agency:
Reason:Reason:
Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT):ATF Trace Form Completed:□NCIC:□
Printed Name:
Signature:
Date:
IB: 24 This form is incomplete without reference to the FD-1087.