DOJ-OGR-00029701.tif

a c FD-340 (Rev. 4-11-03) File Number __ a -_\O 7fAL2 Field Office Acquiring Evidence Mp | Pack a _. Serial # of Originating Document i Date Received — Veer ago GE é From sibutor/Interviewee) é —_ (Address) ~ La City and State} -2 To Be Returned EC] Yes - CeNe { | Receipt Given [1 Yes . ENS | | Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) | Federal Rules of Criminal Procedure ‘ | [] Yes Ci-o- , | Federal Taxpayer Information (FT!) ‘ | C1 Yes exo | Title: j | a | | Reference: | (Comniunication Enclosing Material) | e7 | ‘ | | b6 -3 bc -3 03956-8515 DOJ-OGR-00029701