EFTA00132101



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 Instructions

- □ HAZMAT □ Latents □ FGJ
- □ Req. Charging □ Freeze □ Refrigerate
- □ Biohazard
- □ Other ___

Collected By: MAST NAMMOND
Agency: FBI

Date and Time
9/10/19 10:00 AM

Reason: CAFT

Date and Time
9/12/15 10:00 AM

Reason: RECEIVED

Date and Time
9/13/15 2:00 PM

Reason: ACCEPTED

Date and Time
9/13/15 2:00 PM

Reason: RECEIVED FROM ERF

Date and Time
9/25/15 12:00 PM

Reason: RECEIVED FROM ERF

## Relinquished Custody

Date and Accepted Custody

Signature:
Printed Name/Agency:
Reason:
Relinquished Custody

Time

Signature:
Printed Name/Agency:
Reason:

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

Printed Name:
Signature:
Date:

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

EFTA00132102

## EVIDENCE CHAIN OF CUSTODY

<table border="1"><tr><td rowspan="4"></td><td>Date and Time</td><td>A</td><td></td><td>Date and Time</td></tr><tr><td>9/25/2020</td><td>S</td><td></td><td>25/2020</td></tr><tr><td>12:02</td><td>F</td><td></td><td>2022</td></tr><tr><td>Reason:</td><td colspan="3">Reason:</td></tr><tr><td rowspan="3">Relinquished Custody</td><td>Date and Time</td><td rowspan="3"></td><td rowspan="3"></td><td>Date and Time</td></tr><tr><td>9/25/2020</td></tr><tr><td>11:06am</td></tr><tr><td rowspan="4">Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>6/23/2020</td><td>Signature:</td><td></td><td></td></tr><tr><td>11:06am</td><td>Printed Name/Agency:</td><td></td><td></td></tr><tr><td>Reason:</td><td colspan="3">Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr><tr><td>Relinquished Custody</td><td>Date and Time</td><td>Accepted Custody</td><td>Date and Time</td><td></td></tr><tr><td>Signature:</td><td rowspan="3"></td><td>Signature:</td><td rowspan="3"></td><td rowspan="3"></td></tr><tr><td>Printed Name/Agency:</td></tr><tr><td>Reason:</td></tr></table>

Case ID: 90A-M-3151227 IB: 14 Barcode: €6516207

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