eld Office Acquiring Evidence Serial gor Originating Document (no %/7 a,c2, 472.77/4.44-7 • Date Rcr From (Name of Lontrtbotor/In orvuwee) (Attiress) By V' To Be Returned 0 Yes 0 No Receipt Given 0 Yes 0 No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of