1-03) File Number Field Office Acquiring Evidence yl,‘ !AA P e Serial # of Originating Document Date Received On. it of.A. From ••••••••••• 31E-MA -.1(n-o(na, - 401 (Name oftentributorilnteiviewte) (Addles") • • By To Bo Renamed 0 Yes B10 Receipt Given ID Yes pig& Grand Jury Materia