EFTA00132054



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th colspan="4">Evidence Type: □ General □ Drugs □ Firearms/Wapon<br>□ Digital □ Valuables □ Firearms/Other</th><th colspan="2">Item #</th></tr></thead><tbody><tr><td colspan="3">Special Handling Instructions</td><td>Initial Receipt</td><td rowspan="5">Date and Time<br>8/10/19<br>7:00pm</td></tr><tr><td colspan="3">☐ HAZMAT ☐ Latents ☐ FGJ<br>☐ Req. Charging ☐ Freeze ☐ Refrigerate<br>☐ Biohazard<br>☐ Other ___</td><td>Signature of S</td></tr><tr><td colspan="3"></td><td>Printed Name</td></tr><tr><td colspan="3"></td><td>Reason: Initial</td></tr><tr><td colspan="3"></td><td>Collected By: Agency: FBI</td></tr><tr><td rowspan="2">Rellinquished Signature: Printed Name: Reason: TRANSFER</td><td rowspan="2"></td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>8/19/19 12:30pm</td><td>Signature: Printed Name: Reason: Transferred OTD</td><td>8/19/19 12:30pm</td></tr><tr><td rowspan="2">Rellinquished Custody Signature: Printed Name: Reason: Release NO OTD for Exam</td><td rowspan="2"></td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>8/20/19 8:50am</td><td>Signature: Printed Name: Reason: Received from ERF</td><td>9/12/20 12:00am</td></tr><tr><td rowspan="3">Rellinquished Custody Signature: Printed Name: Reason: Change Out</td><td rowspan="3"></td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>5/16/22 11:50am</td><td>Signature: Printed Name: Reason: change out</td><td>6/12/20 11:50am</td></tr><tr><td>5/16/22 11:50am</td><td>Signature: Printed Name: Reason: change out</td><td>6/12/20 11:50am</td></tr><tr><td rowspan="3">Rellinquished Custody Signature: Printed Name: Reason: Change Out</td><td rowspan="3"></td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>5/16/22 11:50am</td><td>Signature: Printed Name: Reason: change out</td><td></td></tr><tr><td>5/16/22 11:50am</td><td>Signature: Printed Name: Reason: change out</td><td></td></tr><tr><td rowspan="3">Rellinquished Custody Signature: Printed Name: Reason: Change Out</td><td rowspan="3"></td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="2"></td><td>Signature: Printed Name: Reason: change out</td><td></td></tr><tr><td>Signature: Printed Name: Reason: change out</td><td></td></tr><tr><td colspan="5">Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT): ATF Trace Form Completed: □<br>Printed Name: NCIC: □</td></tr></tbody></table>

<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

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