26 4-1 PD-340 (Rev. 4-11-03 File Number Field Office Acquiring Evidence Serial # of Originating Document cly Date Received From (Name of ContributorRnterviewee) (Address) (City and State) By a ------ To Be Returned 0 Yes a'No Receipt Given 0 Yes D 7 No Grand Jury Material - Disseminate Only Pursuan