DOJ-OGR-00029975.tif

FD-340 (Rev. 4-11-03} File Number _“3(S.- MM oe OGra-Khu 2 ; Field Office Acquiring Evidence A C. Serial # of Originating Document __" Date Received VA oS From (Name of Contributor/interviewee} {Address} ~ f {City and State) te To BeRetuned Cl Yes - Receipt Given [1 Yes Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Pederal Rules of Criminal! Procedure {Commiunication Enclosing Material} — [7] Yes EFNo Federal Taxpayer Information (FTI) [] Yes ETNo Title: Reference: -_—_v 1 oreina notes re interview of Lo : 03956- 1133 DOJ-OGR-00029975