00789855 EFTA00789856 •••••• •• ••••••••==•••••..- FD-340 (Rev. 411-03) File Number 3 k-E-1\N C,2_/Avos" Field Office Acquiring Evidence (Nek• ( 11‘. / s 11 &e Serial # of Originating Document Date Received V cul *s From (Name of Comnbutortinteresewee) (Address) Wm/ and Sta By Cl