EFTA00132079



FD-1004
Rev.07-27-2021


EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th>Relinquished Custody</th><th>Date and Time</th><th>Accepted Custody</th><th>Date and Time</th></tr></thead><tbody><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3">11:30</td></tr><tr><td>Printed Name/Agency:</td><td>Printed Name</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody Split From 1821</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3">9:42a 11:50am</td><td>Signature:</td><td rowspan="3">11:30am</td></tr><tr><td>Printed Name</td><td>Printed Name</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3">5/26/03 14:00pm</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name</td><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr></tbody></table>

Case ID: 90A-NY-3151227 IB: 57 Barcode: E6943445

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