DOJ-OGR-00029865.tif

(~ FD-3406 (Rev. 4-11-03) File Number 3 | © - MM - lA FOG2 ~/AIL Field Office Acquiring Evidence MM | | Ace@w Serial # of Originating Document _~ Date Received OS : From (Name of Contributor/Interviewee} ‘ (Address) ~ (City and State) By To Be Returned [J Yes - Receipt Given [] Yes [=+-No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure Ts Y¥es ErNo Federal Taxpayer Information (FTI) . Ly Yes EENe Title: Reference: (Comniunication Enclosing Material) a Description: : Original notes re interview of log rn Ahi - awl ae On DOJ-OGR-00029865