o (D3-%-/$ /07 Field Office Acquiring Evidence n\kn\ ./ P EC 4 Serial # of Originating Document Date Received ll:NY't Cit. vs. From (Name of Caunkurottincrviabea (CO onl State) By PT. A )9 AV' CAA.Acte.lba To De Returned O Yes • U NO Receipt Given O Yes EY—NO— Grand Jury Material - Disseminate Only Pu