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 |
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 |
| Signature: 4/20/19 6:55am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time |
| Signature: 9/20/19 11:50am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time |
| Signature: 7/20/19 11:50am | Signature: |
| Printed Name: Reason: | Printed Name: Reason: |
| Reason: | Reason: |
| Relinquished Custody | Date and Time |
| 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.¶