0129969 ED-340c(4- )1.03) File Number 90A —k\•-t- 2 c 121 -3- Field Office Acquiring Evidence Serial # of Originating Document 3' IL ( i Co. (Maw of Contributor/Wen/env) Date Received From 5IA (_) ki 1/4-4O 1-3 (Address) k)- / tv /out, (City and suit) By SA- 'lb Be Returned El Yes No Receipt Given 0