A01694045 FD•340 (Rev. 4-11-03) File Number ItA31) Field Office Acquiring Evidence tartal Serial it of Originating Document Date Received OY OYAttro r7 From a- (Name ottontributor/Interviewee) (Address) (City and State) By r4 To Be Returned 0 Yes 2 / No Receipt Given 0 Yes [no Grand