EFTA00132092



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 ___

Agency: FBI

Date and Time
8/10/19 10:00 AM

Reason: TO CART

Date and Time
8/15/19 10:00 AM

Reason: RECEIVED

Date and Time
8/15/19 10:20 AM

Reason: TRANSFER

Date and Time
8/15/19 10:00 PM

Reason: RECEIVED FROM EPF

Date and Time
8/15/19 10:20 PM

Reason: TRANSFER

Date and Time
8/15/19 10:00 PM

Reason: TRANSFER

Date and Time
8/15/19 10:00 PM

Reason: TRANSFER

Date and Time
8/15/19 10:00 PM

Reason: TRANSFER

Date and Time
8/15/19 10:00 PM

Reason: TRANSFER

Date and Time
8/15/19 10:00 PM

Reason: TRANSFER

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

- Printed Name:
- Signature:
- Date:

ATF Trace Form Completed: □ NCIC: □

Case ID: 90A-NY-3151227

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

EFTA00132093

## EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th rowspan="3"></th><th>Date and Time</th><th rowspan="3">Accepted Custody</th><th>Date and Time</th></tr><tr><th>9:20</th><th>11:50</th></tr><tr><th>Reason:</th><th>Reason:</th></tr></thead><tbody><tr><td rowspan="3">Relinquished Custody</td><td rowspan="3">Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency: Reason:</td></tr><tr><td>Reason: 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: Reason:</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: Reason:</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: Reason:</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: Reason:</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: Reason:</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: Reason:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr></tbody></table>

Case ID: 40A-M-3151227 IB: 11 Barcode: €6516204

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