/6.— 1.741— ie'ro 6 2- — n g?5- Field Office Acquiring Evidence "k7. — Serial # of Originating Document e/24n, ee Date Received From (Name of Coninbutodlnterviewee) (Address) (City and State) To Be Returned 0 Yes E /No Receipt Given 0 Yes L' No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (