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FD-340 (Rev. 4-11-03) File Number SIE-mm-/egoba 7 g Field Office Acquiring Evidence yw Serial # of Originating Document asl Date Received O3SfIDf Ref From (Name of Contributor/interviewee) (Address) (City and State) pw osaf ToBeRetumed [1 Yes No Receipt Given [I Yes — No Grand Jury Material - Disseminate Only Pursuant to Rute 6 {e) Federal Rules of Criminal Procedure ; OO Yes £4 No Federal Taxpayer Information (FTI) : O Yes [4 No Title: Reference: {Communication Enclosing Material) Description: [1 Original notes re interview of are /, vo b6 -3° b7c -3 b3 -1° 03956-9395