EFTA Document EFTA01338375

1135- FD-340 (Rev. 4.114)) File Number Field Office Acquiring Evidence //Pg.- 201,9 Serial N of Originating Document 111 Date Received From I133;1 - 16 r (Name of CoMriboloolntendevat) (Address) v and State) By To Be Returned K Yes O No Receipt Given 0 Yes 0 No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (e) Federal Rules of Criminal Procedure Yes O No Federal Taxpayer Inf rmation (ETD O Yes O No Title: Reference: (Communication Enclosing Material) De