EFTA00132054¶
FD-1004 Rev. 7-7-2016¶
FEDERAL BUREAU OF INVESTIGATION EVIDENCE CHAIN OF CUSTODY¶
| Evidence Type: □ General □ Drugs □ Firearms/Wapon □ Digital □ Valuables □ Firearms/Other | Item # | ||||
|---|---|---|---|---|---|
| Special Handling Instructions | Initial Receipt | Date and Time 8/10/19 7:00pm | |||
| ☐ HAZMAT ☐ Latents ☐ FGJ ☐ Req. Charging ☐ Freeze ☐ Refrigerate ☐ Biohazard ☐ Other ___ | Signature of S | ||||
| Printed Name | |||||
| Reason: Initial | |||||
| Collected By: Agency: FBI | |||||
| Rellinquished Signature: Printed Name: Reason: TRANSFER | Date and Time | Accepted Custody | Date and Time | ||
| 8/19/19 12:30pm | Signature: Printed Name: Reason: Transferred OTD | 8/19/19 12:30pm | |||
| Rellinquished Custody Signature: Printed Name: Reason: Release NO OTD for Exam | Date and Time | Accepted Custody | Date and Time | ||
| 8/20/19 8:50am | Signature: Printed Name: Reason: Received from ERF | 9/12/20 12:00am | |||
| Rellinquished Custody Signature: Printed Name: Reason: Change Out | Date and Time | Accepted Custody | Date and Time | ||
| 5/16/22 11:50am | Signature: Printed Name: Reason: change out | 6/12/20 11:50am | |||
| 5/16/22 11:50am | Signature: Printed Name: Reason: change out | 6/12/20 11:50am | |||
| Rellinquished Custody Signature: Printed Name: Reason: Change Out | Date and Time | Accepted Custody | Date and Time | ||
| 5/16/22 11:50am | Signature: Printed Name: Reason: change out | ||||
| 5/16/22 11:50am | Signature: Printed Name: Reason: change out | ||||
| Rellinquished Custody Signature: Printed Name: Reason: Change Out | Date and Time | Accepted Custody | Date and Time | ||
| Signature: Printed Name: Reason: change out | |||||
| Signature: Printed Name: Reason: change out | |||||
| Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT): ATF Trace Form Completed: □ Printed Name: NCIC: □ | |||||
| Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT): | ATF Trace Form Completed:□NCIC:□ |
| Printed Name: | |
| Signature: | |
| Date: |
Case ID: 90A-NY-3151227¶
This form is incomplete without reference to the FD-1087.¶