DOJ-OGR-00029331.tif

FD-340 (Rev. 4-11-03) File Number - ; s\e- WU : \¢ iS O62. —-/A /3b Field Office Acquiring Evidence — Serial # of Originating Document Date Received Vy; BCKOO S ; From , ; . : (Name of Contributor/Interviewee} = {Address} City and State By SB ToBeRetumed [1 Yes - CFrNo Receipt Given [] Yes CITNo Grand Jury Material - Disseminate Only Pursuant to-Rule 6 {e} Federal Rules of Criminal Procedure [I Yes Cryo Federal Taxpayer Information (FTI) ; LL} Yes Lio Title: Reference: : - (Compiunication Enclosing Material) . a Description: | 2 Original notes ye interview of ; cS ACB a a a Oe AY ae oy my b6 - 2 b7¢c - 2 wee ee erg tent 3956-6032 _ i DOJ-OGR- 00029331