Ogt (2: Field Office Acquiring Evidence }i)A MicaCW1 Serial if of Originating Document CC / pi Date Received From er- nik 66\2 (Name of of Contributdrfinterviewee) (Address) By To Be Returned 0 Yes Receipt Given 0 Yes DEN° Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of