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¶
| Date and Time | Date and Time | ||
|---|---|---|---|
| Reason: | 11:52:00 | Reason: | 11:52:00 |
| Reason: | Date and Time | Reason: | Date and Time |
| 11:52:00 | 11:52:00 | ||
| 11:52:00 | |||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
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| Reason: | |||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
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| Reason: | |||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
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| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
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| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
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| Reason: | |||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
| Printed Name/Agency: | |||
| Reason: | |||
| Relinquished Custody | Date and Time | Accepted Custody | Date and Time |
| Signature: Printed Name/Agency: Reason: | Signature: | ||
| Printed Name/Agency: | |||
| Reason: |
Case ID: 90A-M-3151227 IB: 13 Barcode: €6516206¶
This form is incomplete without reference to the FD-1087.¶