ld Office Acquiring Evidence V ^ ‘At 1/4-A- • log 06 '/4 i/7 laCP--Or File Number It Serial # of Originating Document Date Received V A- e l'OI 3 S From (Name of Contributor/Interviewee) (Address) By it and State b6 b7C To Be Returned O Yes • 0--146 Receipt Given 0 Yes O -1C Gra