EFTA00132050



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

| Initial Receipt | Date and Time |
| :--- | :--- |
| □ HAZMAT □ Latents □ FGJ | Signature of S/N: 8/12/19 |
| □ Req. Charging □ Freeze □ Refrigerate | Printed Name: 7:00 pm |
| □ Biohazard | Reason: Initial Collection By Agency: FB |
| □ Other | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: 8/16/19 | Signature: 8/16/19 |
| Printed Name: 3:15pm | Printed Name: 3:15pm |
| Reason: | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: 8/16/19 | Signature: 8/16/19 |
| Printed Name: 4:30pm | Printed Name: 4:30pm |
| Reason: | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: 8/19/19 | Signature: 8/19/19 |
| Printed Name: 12:00pm | Printed Name: 12:00pm |
| Reason: | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: 8/19/19 | Signature: 8/19/19 |
| Printed Name: 12:00pm | Printed Name: 12:00pm |
| Reason: | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: 8/19/19 | Signature: 8/19/19 |
| Printed Name: 12:00pm | Printed Name: 12:00pm |
| Reason: | Reason: |

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

- Printed Name:
- Signature:

<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-3151227

1B: 29

Barcode: E6S15207

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