FBI evidence chain of custody form, case 90A-NY-3151227, 2019–2022

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: □

Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT):	ATF Trace Form Completed:□NCIC:□
Printed Name:
Signature:
Date:

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