EFTA00132049



FD-1004
Rev. 10-13-2020


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/Agency:<br>Reason:</td><td rowspan="2">Date and Time</td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td rowspan="2">Date and Time</td></tr><tr><td>Relinquished Custody</td><td>Accepted Custody</td></tr

Case ID: ___ 1B: ___ Barcode: ___

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