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C FD-140 (Rev. 9.11-03) File Number i-APL ccm 06, a_ -ill- in Field Office Acquiring Evidence 4 \ A Serial # of Originating Document Date Received V 113r \ (1O From (Name of Contributor/Interviewee) (Address) (City and Satc) By SL To Be Returned O Yes • Erg; Receipt Given O Yes Ergo Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure 0 yes D-Nir Federal Taxpayer Information (FTI) O Yes Title: I Reference: (ComOrnication Enclosing Material) Description: Original notes re interview of hie MM12-31E-MM-108062-1A SEC 014 SER 1A118-1A131-000038 CONFIDENTIAL 3501.132-013 Page I of 10 EFTA 00066220 EFTA01246740
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