EFTA00132051



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

| Evidence Type: | General | Drugs | Firearms/Weapon | Item # |
| :--- | :--- | :--- | :--- | :--- |
| Digital | Valuables | Firearms/Other | | |

**Special Handling Instructions**

- □ HAZMAT
- □ Latents
- □ FGJ
- □ Req. Charging
- □ Freeze
- □ Refrigerate
- □ Biohazard
- □ Other ___

| Initial Recognition | Date and Time |
| :--- | :--- |
| Signature of Printed Name Reason: In Collected Agency: FBL | 8/19/19 12:30 | 8/19/19 7:00 |

**Relinquished Custody**

- Signature: ___
- Printed Name: ___
- Reason: TRANSFER ___
- Date and Time: 8/19/19 12:30

**Relinquished Custody**

- Signature: ___
- Printed Name: ___
- Reason: Release to OTD or Exemption ___
- Date and Time: 8/19/19 12:30

**Relinquished Custody**

- Signature: ___
- Printed Name: ___
- Reason: Change Out ___
- Date and Time: 5/2/22 11:50

**Relinquished Custody**

- Signature: ___
- Printed Name: ___
- Reason: ___
- Date and Time: 03/03 11:50

**Relinquished Custody**

- Signature: ___
- Printed Name/Agency: ___
- Reason: ___
- Date and Time: ___

**Relinquished Custody**

- Signature: ___
- Printed Name/Agency: ___
- Reason: ___
- Date and Time: ___

**Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):**

- Printed Name:
- Signature:

ATF Trace Form Completed: ☐ NCIC: ☐

Case ID: 90A-NY-3151227

Barcode: E6516228

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

EFTA00132052



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 S
Printed Name
Reason: Initial
Collected By:
Agency: FBI

Date and Time
8/19/19 12:30

Accepted Custody

Signature:
Printed Name
Reason:

Date and Time
8/20/15 6:50

Accepted Custody

Signature:
Printed Name
Reason:

Date and Time
5/12/21 11:54

Accepted Custody

Signature:
Printed Name
Reason:

Date and Time
6/9/20 11:00

Accepted Custody

Signature:
Printed Name/Agency:
Reason:

Date and Time
6/9/20 11:00

Accepted Custody

Signature:
Printed Name/Agency:
Reason:

Date and Time
6/9/20 11:00

Accepted Custody

Signature:
Printed Name/Agency:
Reason:

Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):

ATF Trace Form Completed:
NCIC: ___

Case ID: 90A-NY-3151227

Barcode: 6516229

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

EFTA00132053



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 ___

## Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 8/19/19 12:30pm | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 4/20/19 6:55am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 9/20/19 11:50am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 7/20/19 11:50am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time | Accepted Custody |
| Signature: 7/20/19 11:50am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |

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

- Printed Name:
- Signature:
- Date:

Case ID: 90A-NY-3151227

Barcode: 6516230

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