nce Serial # of Originating Document Date Received \) • < FD-340 (Rev. 4-11-03) File Number - • o 2 0 (0 2 -aSi A! PAcs_Ar. From (Name of Contnbwodlnlerviewee) (Address) By al and State To Be Returned 0 Yes E3—NO' Receipt Given 0 Yes C3-Nts— Grand Jury Material - Disseminate Only Pursuant to Rule