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:
| Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT): | ATF Trace Form Completed:□NCIC:□ |
| Printed Name: | |
| Signature: | |
| Date: |
Case ID: 90A-NY-3151227¶
1B: 29¶
Barcode: E6S15207¶
This form is incomplete without reference to the FD-1087.¶