EFTA00132236 FD-1004 Rev. 7-7-2016 FEDERAL BUREAU OF INVESTIGATION EVIDENCE CHAIN OF CUSTODY E6516336

Special Handling Instructions		Initial Receipt		Date and Time
	☐ HAZMAT ☐ Latents ☐ FGJ	Signature of Seizing Indent		9/26/15 11:00am
	☐ Req. Charging ☐ Freeze ☐ Refrigerate	Printed Name/Agency:
	☐ Biohazard	Reason: Initial Collection
	☐ Other	Collected By: SA Agency:

Relinquished Custody		Date and Time	Accepted Custody	Date and Time
		2:45 8/24/19	Signature: Printed N Reason:	2:45 12/4/19


		8/27/19 3:00	Signature: Printed N Reason:	10/19 8/04


		8/01/19 3:45	Signature: Printed N Reason:	27/19 SASWS


		8/28/19 1232ws	Signature: Printed Name/Agency: Reason:


		Relinquished Custody		Date and Time	Accepted Custody	Date and Time
		Signature:			Signature:
Printed Name/Agency:		Printed Name/Agency:
Reason:		Reason:
Relinquished Custody		Date and Time	Accepted Custody	Date and Time
Signature:			Signature:
Printed Name/Agency:			Printed Name/Agency:
Reason:			Reason:
Firearm Certification by (FI/SWAT) / Explosive Material Certification by (SABT):					ATF Trace Form Completed: NCIC: □
Printed Name:
Signature:
Date:

Case ID: 90A-NY-3151227 Barcode: E6516336 This form is incomplete without reference to the FD-1087.