EFTA00132079¶
FD-1004 Rev.07-27-2021¶
EVIDENCE CHAIN OF CUSTODY¶
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
|---|---|---|---|
| Signature: | Signature: | 11:30 | |
| Printed Name/Agency: | Printed Name | ||
| Reason: | Reason: | ||
| Relinquished Custody Split From 1821 | Date and Time | Accepted Custody | Date and Time |
| Signature: | 9:42a 11:50am | Signature: | 11:30am |
| Printed Name | Printed Name | ||
| Reason: | Reason: | ||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: | 5/26/03 14:00pm | Signature: | |
| Printed Name | Printed Name/Agency: | ||
| Reason: | Reason: | ||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: | Signature: | ||
| Printed Name/Agency: | Printed Name/Agency: | ||
| Reason: | Reason: | ||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: | Signature: | ||
| Printed Name/Agency: | Printed Name/Agency: | ||
| Reason: | Reason: | ||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: | Signature: | ||
| Printed Name/Agency: | Printed Name/Agency: | ||
| Reason: | Reason: | ||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: | Signature: | ||
| Printed Name/Agency: | Printed Name/Agency: | ||
| Reason: | Reason: | ||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: | Signature: | ||
| Printed Name/Agency: | Printed Name/Agency: | ||
| Reason: | Reason: |
Case ID: 90A-NY-3151227 IB: 57 Barcode: E6943445¶
This form is incomplete without reference to the FD-1087.¶