EFTA00132095




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 4:30pm

Reason: TO CART

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

Reason: RECEIVED

Date and Time
8/15/19 2:00PM

Reason: ACCEPTED

Relinquished Custody Date and Time Accepted Custody Date and Time

Reason: Transfer to OTD Reason: Received from ERF

Relinquished Custody Date and Time Accepted Custody Date and Time

Signature:
Printed Name/Agency:
Reason:

Relinquished Custody Date and Time Accepted Custody Date and Time

Signature:
Printed Name/Agency:
Reason:

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

Printed Name:
Signature:
Date:

Case ID: 90A-NY-3151227

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