DOJ-OGR-00029813.tif

FE-340 (Rev. 4-11-03} File Number 3 ( S- -! OS = | i Field Office Acquiring Evidence Muu | Pace | Serial # of Originating Document Date Received VAriod Gs ‘ From . (Name of Contributor/Interviewee) | a , (Address) . ~~ & By (OB To Be Retumed []’ Yes - [No Receipt Given [1 Yes E-No- Grand Jury Material - Disseminate Only Pursuant to Rule 6 {e) Federal Rules of Criminal Procedure T] Yes bio Federal Taxpayer Information (FTD C1 Yes Ca Title: Reference: : (Comniunication Enclosing Material) ae Description: [J Original notes xe mis of = SA a — Sun fe 03956-8841 DOJ-OGR-00029813