EFTA00132060



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 |
| :--- | :--- |
| Signature: 8/21/19 | Signature: 8/22/19 |
| Printed Name: 12:04pm | Printed Name: 12:04pm |
| Reason: To EVIDENCE | Reason: Cheddar In Storage |
| Date and Time | Accepted Custody |
| Signature: 5/9/27 | Signature: 5/9/27 |
| Printed Name: 11:50am | Printed Name: 11:50am |
| Reason: Change 04 | Reason: Change 04 |

## Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: 5/3/23 | Signature: |
| Printed Name/Agency: | Printed Name/Agency: |
| Reason: | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: | Signature: |
| Printed Name/Agency: | Printed Name/Agency: |
| Reason: | Reason: |

## Relinquished Custody

| Date and Time | Accepted Custody |
| :--- | :--- |
| Signature: | Signature: |
| Printed Name/Agency: | Printed Name/Agency: |
| Reason: | Reason: |

## Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):

- Printed Name:
- Signature:
- Date:

Case ID: 90A-NY-3151227 1B: 43 Barcode: €6515258

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

EFTA00132061



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 # NY1023654**

### Special Handling Instructions

| Initial Receipt | Date and Time |
| :--- | :--- |
| □ HAZMAT □ Latents □ FGJ □ Req. Charging □ Freeze □ Refrigerate □ Biohazard □ Other ___ | Signature of Seizing Individual 8/08/15 Printed Name/Agency 5:00PM Reason: Initial Collection Collected By: Agency: PBI |

### Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: Printed Name/Agency: Reason: Submit to ECU | 9/3/19 8:00AM Signature: Printed Name/Agency Reason: CAST | 9/3/19 7:40AM Signature: Printed Name/Agency Reason: CAST |

### Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: Printed Reason: LOC to SA | 12/6/29 10:25 Signature: Printed Reason: CAST | 12/6/29 10:00 Signature: Printed Reason: CAST |

### Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: Printed Reason: LOC to CAST | 12/6/19 10:04 Signature: Printed Reason: CAST | 12/6/19 10:24 Signature: Printed Reason: CAST |

### Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: Printed Reason: TO EVIDENCE | 10/11/19 Signature: Printed Reason: CAST | 10/11/19 Signature: Printed Reason: CAST |

### Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: Printed Reason: Change Out | 5/2/22 Signature: Printed Reason: CHANGE OUT | 5/2/22 Signature: Printed Reason: CHANGE OUT |

### Relinquished Custody

| Date and Time | Accepted Custody | Date and Time |
| :--- | :--- | :--- |
| Signature: Printed Reason: Transfer to DRIVER | 5/3/20 Signature: Printed Reason: CHANGE OUT | Signature: Printed Reason: CHANGE OUT |

### Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):

- Printed Name:
- Signature:
- Date:

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