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hillary-r -clinton — Part 14
Page 18
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ALL INFORLATION CONTAINED
HEREIN IS UNCLASSITIEC
DATE 08-18-2017 3YJ3785T94 NSIC
1 Ayq
F340Rev.4-1103
File Number
Ficld Officc Acquiring Evidence
S 1
Seriat # of Originating Document.
Date Received
n)-ht-t
From
(Namc of Coniribuior/inicrviewee)
{Address}
City and State
By
To Be Retumed Yes
N
Receipt Given
No
Grand Jury Material - Disseminate Only Pursyant to Rule 6(e)
Federal Rules of Criminal Procedure
Yes
No
Federal Taxpayer Information (FTI)
seA
No
M.d year
Exam
Retum PuA-B
Reference:
(Communication Enclosing Materiai)e
CJ Cagt
Description:
Original notes re interview of
RC-5054
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