K. Field Office Acquiring Evidence SO(0, —11413 D P6c .9_..i. Serial # of Originating Document Date Received r) O S From (Name otContnbutor/Intemewee) (Addriss) ••• By SA /rd./ anciStmel To Be Returned 0 Yes 0 No Receipt Given 0 Yes Grand Jury Material - Disseminate Only Pursuant to Rul