DOJ-OGR-00029397.tif

FD-340 (Rev. 4-11-03) File Number “3 6 XY Ni ae lOTOGA. “/AIS ; Field Office Acquiring Evidence ONY P&B es Serial # of Originating Decument ne Date Received CoN 1QL& From - (Name of Contribulor/nterviewee) ‘ 7 (Address) - ‘ ’ 3 ™~ : City and State b6 -2 By b?c -2 ToReRetumed C] Yes - CrNo Receipt Given [I Yes ON Grand Jury Material - Disseminate Only Pursuant to Rule 6 (€} Federal Ruies of Criminal Procedure El Yes Chto Cha Federal Taxpayer Information (FIT) . - 4 Yes Title: % Reference: {Compiuntcation Buefosing Material) ar all * ee ee Description: ([] Original notes re interview of 5, -& 5,-8 i I “ ik. . + 03956-5769 DOJ-OGR- 00029397