oe bt-22.0\17 Nvi5PACE, Accoumt • EFTA01727934 it C F0440 (Rev. 4-11-03) File Number , )t.c r1 1 5 Field Office Acquiring Evidence ••\, ? P CP- Pr I Serial # of Originating Document • Date Received t J S From Ott011tal UtOdhllerelaYet) (Address) By • To Be Resumed 0 Yes • -12-1C6-