a @ NN -C20 lAZBS FD-340c(4-11-03) File Number ° l Serial # of Originating Document GS@ Date Received lela: From (Name of Contributor/Interviewee) (Address) By ToBeReturned [[] Yes [1] No Receipt Given [[] Yes 1 No Grand Jury Material - Disseminate Only Pursuant to Rule 6 (@) Federal Rules of Criminal Procedure CO ves (1 No Federal Taxpayer Information (FTD oO Yes Ol No Title: Reference: . Description: [—] Original notes re interview of Ref: Date: O60ct21 SHIPPING: 7.11 Dep: Mgt? 3.25 LBS SPECIAL: 0.00 HANDLING: 0.00 Dv: 0.00 TOTAL: 7.al Svos: STANDARD OVERNIGHT DSR TROM: 164 WOS7 1800 ee EFTA00257784

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10/6/2021 50D-NY-3027571 - 30 Type: Precedence: From: Contact: Drafted By: Approved By: Case: Reference Document: Details: Location 1 To: Status: Recipient: Assigned: Created: Due: 10/06/2021 10/13/2021 Action Required Priority DENVER, DN-CR-8 2 ea SSA SSA 50D-NY-3027571 Phone: Lead: 30 50D-NY-3027571 Serial 654 (U) Request Evidence Item 1B139 be transferred to FBI NY ECR. DN-EVIDENCE Assigned DN-EVIDENCE 10/06/2021 ty iy No Coverage Information Activity Log Ww EFTA00257785

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FedEx ° October 07, 2021 Dear Customer, The following is the proof-of-delivery for tracking number: 186409671500 Delivery Information: Sec c Status: Delivered Delivered To: Residence Signed for by: LARRY Dolivory Location: 26 FEDERAL PLAZA 23RD FLOOR Service typo: FedEx Standard Ovemight Special Handling: Dee eet ce suired NEW YORK, NY, 102780004 Delivery date: Oct 7, 2021 15:08 ‘Shipping Information: Tracking number: 186409671500 Ship Date: Oct 6, 2021 Welght: 4.0 LBI1.82 KG Recipient: Shipper: ATTN: ECR, FBI NEW YORK FBI, MAILROOM, FBI 26 FEDERAL PLAZA 8000 E. 36TH AVENUE 23RD FLOOR DENVER, CO, US, 80238 NEW YORK, NY, US, 102780004 Thank you for choosing FedEx EFTA00257786