EFTA Document EFTA01338437

%art 'gine FD-340 (Rev. 4-11-03) File Number 7,2 -mm -1 13327- /4 15 Field Office Acquiring Evidence ...AA/14 .44 Serial If of Originating Document .3 Date Received 9 7 -' 28 7 .11 - -0 From 1 61 (Name of Contributoffinterviewee) (Address) (City and State) By -/aR Y a 0#2.-t 3 nilA To Be Returned 0 Yes gp,No Receipt Given 0 Yes No Grand Jury Material - Disseminate ly Pursuant to Rule 6 (c) Federal Rules of Criminal Procedure 0 Yes Federal Taxpayer Information (FTI