EFTA00132055



FD-1004
Rev. 7-7-2016


FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

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

**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: FBI | 8/19/19 7:00pm |

**Rellinquished Custody**

- Signature: 8/19/19
- Printed Name: 12:39pm
- Reason: Transfer to OTD

**Rellinquished Custody**

- Signature: 8/21/19
- Printed Name: 850m
- Reason: Received from ERF

**Rellinquished Custody**

- Signature: 5/2/22
- Printed Name: 11:50m
- Reason: Change Out

**Rellinquished Custody**

- Signature: 5/3/22
- Printed Name/Agency:
- Reason:

Case ID: 90A-NY-3151227

Barcode: < 651632

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

EFTA00132056

# FD-1004

Rev. 7-7-2016

FEDERAL BUREAU OF INVESTIGATION
EVIDENCE CHAIN OF CUSTODY

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

**Special Handling Instructions**

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

| Initial Receipt |
|----------------|
| Signature of |
| Printed Name |
| Reason: Initi |
| Collected By |
| Agency: FDI |

**Relinquired Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Relinquished Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Relinquished Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Relinquished Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Relinquished Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Relinquished Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Relinquished Custody**

| Date and Time |
|--------------|
| Accepted Custody |
| Date and Time |

**Firearm Certification by (F1/SWAT) / Explosive Material Certification by (SABT):**

| ATF Trace Form Completed: |
|--------------------------------|
| NCIC: □                        |

<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>

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