EFTA00132044



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th colspan="4">Evidence Type: □ General □ Drugs □ Firearms/Weapon<br>□ Digital □ Valuables □ Firearms/Othe: Item # ___</th></tr></thead><tbody><tr><td colspan="2">Special Handling Instructions</td><td>Initial Receipt</td><td>Date and Time</td></tr><tr><td colspan="2">☐ HAZMAT ☐ Latents ☐ FGJ<br>☐ Resq Charging ☐ Freeze ☐ Refrigerate<br>☐ Biohazard<br>☐ Other ___</td><td>Signature of Seizing Inc.<br>Printed Name/Agency:<br>Reason: Initial Collection<br>Collected By:<br>Agency: FBI</td><td>8/10/197:00pm</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>8/16/192:00pm</td><td>Signature:<br>Printed N<br>Reason: Changed Storage</td><td>8/26/192:20pm</td></tr><tr><td>8/16/1914:30pm</td><td>Signature:<br>Printed N<br>Reason: CHART</td><td>8/16/194:30pm</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>8/19/1912:30pm</td><td>Signature:<br>Printed N<br>Reason: Transport to OTD</td><td>8/19/1912:30pm</td></tr><tr><td>8/20/19850m</td><td>Signature:<br>Printed N<br>Reason: Received from ERF</td><td>9/15/2011:50am</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>7/16/2011:50m</td><td>Signature:<br>Printed N<br>Reason: Change out</td><td>9/20/2011:50am</td></tr><tr><td>5/202111:50m</td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td></td></tr></tbody></table>

<table border="1"><tr><td>Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT):</td><td rowspan="4">ATF Trace Form Completed:□NCIC:□</td></tr><tr><td>Printed Name:</td></tr><tr><td>Signature:</td></tr><tr><td>Date:</td></tr></table>

Case ID: 90A-NY-3151827

IB: 25

Barcode: E6515203

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