Name of Witness

Name of Witness UNITED STATES DEPARTMENT OF JUSTICE Office of the Inspector General WARNINGS AND ASSURANCES TO EMPLOYEE REQUESTED TO PROVIDE INFORMATION ON A VOLUNTARY BASIS You are being asked to provide information as part of an investigation being conducted by the Office of the Inspector General. This investigation is being conducted pursuant to the Inspector General Act of 1978, as amended. This investigation pertains to: \\ O 11 ?cc -tom Mekil(a P fic-c tm" 4L I ute_ This is a voluntary interview. Accordingly, you do not have to answer questions. No disciplinary action will be taken against you if you choose not to answer questions. Any statement you furnish may be used as evidence in any future criminal proceedings or agency disciplinary proceeding, or both. WAIVER I understand the warnings and assurances stated above and I am willing to make a statement and answer questions. No promises or threats have been made to me and no pressure or coercion of any kind has been used against me. E Em 4-I2•Xl iOrt) Date and Time TC.1 Thonbv1m 5i76 ina;rayyt Place I 6444 OIG Form 111.226/2 (05/03/21) Non-CustodiaWmployee EFTA00063394