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CO (~ | File Number S3\e- MM - Oo s Ol2. “fA I22- Field Office Acquiring Evidence Mu] Peck pm Serial # of Originating Document Date Received J he( Ov) => _ FD-340 (Rev, 4-11-03) From | (Name of Contributor/Interviewee) {Address} By ToBeRetuned [I Yes - CrNo Receipt Given [1 Yes Cho Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure [] Yes Federal Taxpayer Information (FTL No 1 Yes ote Title: Reference: {Compiunication Enclosing Materia?) Neo 1 Description: _ a Original notes re interview of . p. OC) Po fy 4 <a 03956-8451 b6 -2 b7c -2