EFTA00132098



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 # 13

Special Handling Instructions

☐ HAZMAT ☐ Latents ☐ FGJ
☐ Req. Charging ☐ Freeze ☐ Refrigerate
☐ Biohazard
☐ Other ___

Agency: FBI

Date and Time
8/10/19
1:30 pm

Reason: TO CART

Date and Time
8/12/19
10:00 am

Reason: TO C/A

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

Reason: TO C/A

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

Reason: TRANSFER

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

Reason: TRANSFER

Reinquished Custody

Signature:
Printed Name/Agency:

Reason:

Reinquished Custody

Signature:
Printed Name/Agency:

Reason:

Reinquished Custody

Time

Signature:
Printed Name/Agency:

Reason:

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

ATF Trace Form Completed:
NCIC: □

Case ID: 90A-NY-3151227

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

EFTA00132099

## EVIDENCE CHAIN OF CUSTODY

<table><thead><tr><th></th><th>Date and Time</th><th></th><th>Date and Time</th></tr></thead><tbody><tr><td>Reason:</td><td>11:52:00</td><td>Reason:</td><td>11:52:00</td></tr><tr><td rowspan="3">Reason:</td><td>Date and Time</td><td rowspan="3">Reason:</td><td>Date and Time</td></tr><tr><td>11:52:00</td><td rowspan="3">11:52:00</td></tr><tr><td>11:52:00</td></tr><tr><td rowspan="4">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td></tr><tr><td rowspan="3">Signature:<br>Printed Name/Agency:<br>Reason:</td><td>Signature:</td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr></tbody></table>

Case ID: 90A-M-3151227 IB: 13 Barcode: €6516206

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