EFTA00132104



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 # 15 |

**Special Handling Instructions**

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

Reason: TO CART

Reason: RECEIVED

Reason: TRANSFER

Reason: RECEIVED FROM EPF

**Relinquished Custody**

Signature:
Printed Name/Agency:
Reason:

**Relinquished Custody**

Signature:
Printed Name/Agency:
Reason:

**Relinquished Custody**

Signature:
Printed Name/Agency:
Reason:

**Firearm Certification by (FU/SWAT) / Explosive Material Certification by (SABT):**

Printed Name:
Signature:
Date:

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

EFTA00132105

## 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>11:30am</td><td>Reason:</td><td>11:30am</td></tr><tr><td rowspan="4">Relinquished Custody</td><td rowspan="4">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:</td></tr><tr><td>Reason:</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:</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:</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:</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:</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:</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:</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:</td></tr><tr><td>Reason:</td><td>Reason:</td></tr></tbody></table>

Case ID: 90A-M-3151227 IE: 15 Barcode: €6516208

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