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ts FD-.340 (Ilea. 4-11-03) I It 31% File Number 3I — Mr1 48 -036D Field Office Acquiring Evidence it) Serial N of Originating Do anent Let, 63 Date Received 5 21 Z0O% From (Name co ntributor/Interviewcc) (Address) (City and State) ,By To Be Retuned O Yes O No Receipt Given O Yes K No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules ofCriminal Procedure K Yes K No Federal Taxpayer Information (FTD O Yes O No Title: Reference: (Communication Enclosing Material) Description: O Original notes re interview of agt61 segia -a; EFTA00024270
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