ce Acquiring Evidence Serial # of Originating Document 41740 r /43 Date Received 5 4.1 4 _awe From ame o utor/Interviewee) (Address) To Be Retumed Yes No Receipt Given 0 Yes 0 No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure 0 Yes 0