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Simla ee FD-840 (Rel 4:2:65) Fieid-File:No: - eet \t Serial. # of Originating Hocument | 00.and FileNo. _/9 BLA icon! Supe Date Recelved 3iaaige From GT _ (Name of Contributor) © _ (Address of Contributor) — (City and State) By . a : on {Name of Special Agent) To Be Returned Yes [] No Receipt Given Yes [1 No Grand Jury Material - Disseminate Only Pursuant to Rule. 6(e), Federal Rules of Criminal Procedure 0 Yes O No Title: Reference: (Communication. Enclosing Material) Description: —E}-Griginal motes 76 Interview of OTE . ron me we eee - ‘ye ‘. b6 bIC