EFTA00132057 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 Recommendation Signature: Printed N: Reason: Collected Agency: Date and Time Accepted Custody Signature: Printed N: Reason This form is incomplete without reference to the FD-1087. EFTA00132058 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 Seizure Printed Name/Agency Reason: Initial Custody Collector: By: Agency: Date and Time 8/14/19 11:30 PM Relinquished Custody Date and Time 8/16-19 5:47 PM Accepted Custody Date and Time 8/14/19 5:47 PM Relinquished Custody Date and Time 8/20/19 3:00 PM Accepted Custody Date and Time 8/20/19 3:00 PM Relinquished Custody Date and Time 5/20/22 11:50 PM Accepted Custody Date and Time 5/3/22 11:50 PM Accepted Custody Date and Time 5/3/22 11:50 PM Relinquished Custody Date and Time 5/3/22 11:50 PM Accepted Custody Date and Time 5/3/22 11:50 PM Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT): Printed Name: Signature: Date: Barcode: E6S15232 This form is incomplete without reference to the FD-1087. EFTA00132059 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 | Date and Time | | :--- | :--- | :--- | | Signature: | Signature: | Signature: | | Printed Name: | Printed Name: | Printed Name: | | Reason: | Reason: | Reason: | ## Relinquished Custody | Date and Time | Accepted Custody | Date and Time | | :--- | :--- | :--- | | Signature: | Signature: | Signature: | | Printed Name: | Printed Name: | Printed Name: | | Reason: | Reason: | Reason: | ## Relinquished Custody | Date and Time | Accepted Custody | Date and Time | | :--- | :--- | :--- | | Signature: | Signature: | Signature: | | Printed Name: | Printed Name: | Printed Name: | | Reason: | Reason: | Reason: | ## Relinquished Custody | Date and Time | Accepted Custody | Date and Time | | :--- | :--- | :--- | | Signature: | Signature: | Signature: | | Printed Name: | Printed Name: | Printed Name: | | Reason: | Reason: | Reason: | ## Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT): Printed Name: Signature: Case ID: 90A-NY-3151227 1B: 42 This form is incomplete without reference to the FD-1087.