r 31 — 013 °cop._ //493 Field Office Acquiring Evidence lANWN i 9 RC 2_ Pr Serial # of Originating Document Date Received \,/ From (Name of ContnbutoMmemevice) (Address) BY A - (City and Slate) To Be Returned O Yes Receipt Given O Yes O No Grand Jury Material - Disseminate Only Pursuant to Rule 6