- I In, Field Office Acquiring Evidence P " Serial # of Originating Document 1 Date Received gi ) 1 I 2.0k From lA C-e- O O-A, (Name of ContrIbutor/Idervievree) (Address) By To Be Returned Q Yes No Receipt Given 0 Yes No Grand Jury Material- Disseminate Only t to Rule 6 (e) Federal Rules of Criminal