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File Number DAZ MA W- | O0%06 2. -/A/37 Field Office Acquiring Evidence See L PRc eA Serial # of Originating Document | FD-340 (Rev. 4-11-03) | 1 { | 4 Date Received «WA TOS From : (Name of Contributor/Interviewee) i (Address) ~ (City and State) By ToBeRetumed C] Yes - EENe- rs - Receipt Given [1 Yes E-No- . Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure 1 Yes (a4e— Federal Taxpayer Information (FTI) 1 Yes (=. No— Title: Reference: {Comniunication Enclosing Material) ae 8 b3 - 1 iption: | [1 Original notes re interview of