a Field Office Acquiring Evidence Ir YM111.\- / P R 0 .Ce 6. Serial ft of Originating Document ' Date Received Q Ai \ at—k-S, From (Name of Contrtbutorilntemewee) N. . . (Address) - 7. (City and State) By CS+ To Be Returned 0 Yes • GI—No Receipt Given 0 Yes En; Grand Jury Material - Disseminat