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ALL INEORATION CONTAINEL HEREIN IS UNCLASSIFIED DATE 01-03-2017 BY J76J18T80 NSICG IArZ FD-340 (Rev. 411-03) b3 File Number b7E Field Office Acquiring Evidence W F 25 Serial # of Originating Document 1019-145 Date Received b3 b6 From (yame or connibutor/Interviewee) b7C b7E (Address) (City and State) b6 By b7C To Be Retumed Yes D/No No Grand Jury Material - Disseminate Oniy Pursuant to Rule 6 (e) Federai Rules of Criminal Procedure No Federal Taxpayer Information (FTI) Yes No Title: b3 Shbpieree Renny Referenc b7E (Communication Enclosing Material) Original notes re interview of Description: b3 Sancene Renm. b7E AU HRC-3781