-"l4/4'r Field Office Acquiring Evidence K1) t1/4-4 I N3CR- r- Serial # of Originating Document Date Received Front By \J-errt ;0 (Name of Combuicalnicruextel (Address) To Be Returned K Yes • ra—rra-- Receipt Given K Yes Eng — Grand Jury Material - Dissaninate Only Plusuant to Rule 6 (e) Federal Rules