DOJ-OGR-00030065.tif

FD-340 (Rev. 4-11-03} File Number St1E- mm- /e e062. ~ R ! Field Office Acquiring Evidence rt ne : as] Serial # of Originating Document__. =O? i Date Received — 03f/infaoit : From (Name of Contributor/interviewee) i | (Address} (City and State) i] b6 -2' ToBeRetumed [1 Yes ft No Receipt Given [I Yes [4 No Grand Jury Material - Disseminate Only Pursuant to Rute 6 {e} Federal Rules of Criminal Procedure ; {J Yes £4 No Federal Taxpayer Information (FTI) , C} Yes [+t No Title: i Reference; : {(Communicztion Enclosing Material} I Description: [4 Original notes re interview of ac l do ; b7c -3 b3 -1: 03956-9395 DOJ-OGR-00030065