EFTA00132083 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 # ___
Special Handling InstructionsDate and Time
8/10/19
4:30pm
Connected By:
Agency: FB1		Date and Time
□ HAZMAT □ Latents □ FGJ
□ Req. Charging □ Freeze □ Refrigerate
□ Biohazard
□ Other ___
Relinquished Custody
Reason: TO CART
Relinquished CustodyDate and Time
8/12/19
10:00am
Reason: CAH		Date and Time
8/12/19
10:00am
Reason: CAH
Signature:
Printed Name
Reason: TO CAHDate and Time
8/15/19
2:00am
Reason: RECEIVED		Date and Time
8/15/19
2:00am
Reason: RECEIVED
Relinquished Custody
Signature:
Printed Name8/15/19
2:00am
Reason: ACCEPTED		Date and Time
8/15/19
2:00am
Reason: ACCEPTED
Reason: TRANSFER
Relinquished Custody
Signature:Date and Time
8/17/19
7:00pm
Reason: RECEIVED		Date and Time
9/25/20
2:00am
Reason: RECEIVED
Printed Name
Reason: Transfer to OTD
Relinquished CustodyDate and TimeAccepted CustodyDate and Time
Signature:Signature:
Printed Name/Agency:Printed Name/Agency:
Reason:Reason:
Relinquished CustodyDate and TimeAccepted CustodyDate and Time
Signature:Signature:
Printed Name/Agency:Printed Name/Agency:
Reason:Reason:
Firearm Certification by(FI/SWAT)/Explosive Material Certification by(SABT):ATF Trace Form Completed:□NCIC:□
Printed Name:
Signature:
Date:
EFTA00132084 EVIDENCE CHAIN OF CUSTODY
Relinquished CustodyDate and Time
Signature:Reason:
Printed Name/Agency
Reason:
Relinquished CustodyDate and TimeAccepted CustodyDate and Time
Signature:Signature:
Printed Name/Agency:Printed Name/Agency:
Reason:Reason: Case ID: 904-M-315227 IB: 8 Barcode: E6516201 This form is incomplete without reference to the FD-1087.