FD-340 (Rev 4.11.03) File Number Field Office Acquiring Evidence Serial # of Originating Document -#4' 139 Date Received j id/ 021 2-0 From (Nance( Contributoranterviewe:) (Address) (City and Suit) By 5 -4 To Be Returned K Yes BKNo Receipt Given El Yes ErNo Grand Jury Material - Disseminate Only Pursuant to