EFTA00132080



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 | Initial Receipt | Date and Time |
| :--- | :--- | :--- |
| □ HAZMAT □ Latents □ FGJ □ Req. Charging □ Freeze □ Refrigerate □ Biohazard □ Other | Signature of Signed Printed Name/Reason: Initial Collected By: Agency: FBI | 8/10/19 4:30 pm |

## Relinquished Custody

- **Signature:** [Blank]
- **Printed Name:** [Blank]
- **Reason:** TO CART
- **Date and Time:** 8/12/19 10:00 AM
- **Accepted Custody:** [Blank]
- **Date and Time:** 8/12/19 10:00 AM
- **Reason:** Received from CRF

## Relinquished Custody

- **Signature:** [Blank]
- **Printed Name:** [Blank]
- **Reason:** TRANSFER
- **Date and Time:** 8/15/19 10:00 AM
- **Accepted Custody:** [Blank]
- **Date and Time:** 8/15/19 10:00 AM
- **Reason:** Received from CRF

## Relinquished Custody

- **Signature:** [Blank]
- **Printed Name:** [Blank]
- **Reason:** TRANSFER
- **Date and Time:** 8/15/19 10:00 AM
- **Accepted Custody:** [Blank]
- **Date and Time:** 8/15/19 10:00 AM
- **Reason:** Received from CRF

## Relinquished Custody

- **Signature:** [Blank]
- **Printed Name/A**
- **Reason:** Transfer to OTD
- **Date and Time:** 8/16/19 3:44 PM
- **Accepted Custody:** [Blank]
- **Date and Time:** 9/15/20 22:00 AM
- **Reason:** Received from CRF

## Relinquished Custody

- **Signature:** [Blank]
- **Printed Name/A**
- **Reason:** Transfer to OTD
- **Date and Time:** 8/16/19 3:44 PM
- **Accepted Custody:** [Blank]
- **Date and Time:** 9/15/20 22:00 AM
- **Reason:** Received from CRF

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

- **Printed Name:**
- **Signature:**
- **Reason:**

ATF Trace Form Completed: □ NCIC: □

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

EFTA00132081

EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th>Re-requisited Custody</th><th>Date and Time</th><th>Accepted Custody</th><th>Date and Time</th></tr></thead><tbody><tr><td>Signature:<br>Printed Name:<br>Reason:</td><td>9:20 am<br>11:30 am</td><td>Signature:<br>Printed Name:<br>Reason:</td><td>9:20 am<br>11:50 am</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:<br>Printed Name:<br>Reason:</td><td>10:10 am<br>11:50 am</td><td>Signature:<br>Printed Name/Agency:<br>Reason:</td><td></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:<br>Printed Name/Agency:<br>Reason:</td><td>

Case ID: 40A-M-3151227 IB: 1 Barcode: E6516200

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