cquiring Evidence Serial # of Originating Document " Date Received \I Pc n 6 O S From e" \ kitt-k- lootc)2_. - /A A2 ( PRc_2_40t (Name of Contributonintetvxwee) (Address) (City and State) By Pt To Be Returned O Yes • U -No Receipt Given O Yes Grand Jury Material - Disseminate Only Pursuant to Rule