DOJ-OGR-00030140.tif

.FD-340 (Rev. 4-11-03) File Number Bl E _ I Um- LOXO>2_ SK /] Field Office Acquiring Evidence _.§ (Viv NY § CRA- ‘Serial # of Originating Document | Date Received On / 2d OS From of Contributor/Interviewee) (Address) ; By . To Be Returned Yes lo ReceiptGiven (1 Yes Deno Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure . - CY Yes Ce . : Federal Taxpayer Information (FT) CJ Yes No Title: Reference: (Communication Encbsing Material) . " er cn a re we ~ a fete aal a REE AE na eee ick eh ch dene Lt alg dt ie aca DOJ-OGR-00030140