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1 see tie eeeentnnaimieememne, FD-340 (Rev. 4-11-03) File Number slE- Mi ~1O es) G2-lthIF ; Field Office Acquiring Evidence i Me Ww f £ Cis L Serial # of Originating Documeyt Date Received OV (e L09% (Name of Contributor/Interviewee) (Address) b6 -2 b7c -2 By § To Be Retumed LJ Yes No i Receipt Given C1 Yes 1 No: ; Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) \ Federal Rules of Criminal Procedure i CO yes 1 No i Federal Taxpayer Information (FTI) | : O Yes [] No f Title: } } q | Reference: ‘ (Communication Enclosing Material) Description: &l—onginarnores te interview ef—~—_.. I . “ yearn - 3 ir ™ i Rae 03956-10599