55 1 1 3 I-EEZEE 13 - 52595 BEE 03435-3832 Bit 633333535313 am aabjaio 7j31f $ To Director FBI 3 Attn CID 333p h SectIon L For FBIField Office use only From SAC Cii t i rs i 8 3 5 13 - Notification of SAC AGtIErityGranted for Use of f TItle 3 33 533 53 5' CONSENSUAL Monitoring Equipment 83ft Check only one 11 3 if 5 pm 2 33 53 333 35 03 33 aeratewce CRROUHNG Use a r- v11 Tr it 1 Reason for Proposed Use Check CI Corroborate CI Protect E3 Protect Testimony Consenting Government Evidence Party Property Other Specify 3 Consenting Party identify ONLY on Field Office Copy Nonconfidential Party Confidential Source CI Cooperative Witness CI Emergency Use S_ensitive Ci clings nces cannot exceed 30 days may be extended 0 Bil-i0 ii i This form inustbAetyp ewritten nf squ d within 10 working days of the dateratIthorIty 1S grant assho In Item 5 below 2 Type of Equrpment Check Transmitter Receiver CIConcealed Recorder CI CCTV Audio Video CICCTV Video only Microphone ITeIephone I21 Other Specify Estates treatises 4 lnterceptee s Include Title if Public Official eight Seams Seinereity Cgilzg we as Sigizteezi g ercpesea Sci others as yet unknown 5 Duration of proposed use 5- Equipment Concealed 7 City State where Equipment will Authorized On 3 In a Motel Rm CI In a Telephone be used-3313533 13 31 the duration of investigation In a Residence On a Person For 30 days Emergency NTCM usage a Vehicle Expiring On C other Specufy 8 The foliowing mandatory requirements have been met Consenting party has agreed to testify Consenting party has executed a consent form Recording transmitting device will be activated only when consenting party is present 1D Violation s Title s 3i Sec s 1 3 use 9 in judicial district where monitoring and or recording will take place has been contacted foresees no entrapment 8 concurs in the use of the technique UtiYes No Date of Contact 53IdentIty of Gov't Atty m3 533 Judicial District 3 nii tt ti r3 tm i i 5H stem- rt at Fri 3 11 DOJ notification required 3 Yes Eligible If Yes check reason below NOTE Requests for Routine NTCM usage involving any of the 7 sensitive circumstances requires a teletype to HQ prepared in the format described in the MIOG Part II Section 10-103 8 Request for Emergency NTCM usage involving Item 6 below requires immediate contact with the FBIHQ substantive desk for DOJ approval The 7 sensitive circumstances do not apply to the use of CCTV video only relating to the performance of his her official duties officers CID DUB Interception relates to an investigation of a member of Congress a Federal Judge a member of the Executive Branch at Executive Level IV or above or a person who has served in such capacity within the previous 2 years Interception relates to an investigation of any public official and the offen e investigated is one involving bribery conflict of interest or extortion Interception relates to an investigation of a Federai law enforcement official Consenting nonconsenting party is a member of the diplomatic corps of a foreign country Consenting nonconsenting party is or has been a member of the Witness Security Program and that fact Is known to the agency involved or its Consenting nonconsenting party is inthe custody of the Bureau of Prisons or the U S Marshals Service Attorney General Deputy Attorney General Associate Attorney General Assistant Attorney General for the Criminal Division or the U Attorney in the district where an investigation Is being conducted has requested the investigating agency to obtain prior written consent for making a consensual interception In a specific investigation 12 Synopsis of Case Attach additional page if necessary illeaea see attacker 13 Justification statement necessitating emergency authorization Emergency 30 day authorization granted due to imminent need within 48 hours for use of consensual monitoring device s which precluded the handling of this request in the usuai manner CI Other Attach Additional Page to Specify 1-Government Attorney's OfTice Attn Field Approval 14 CD6 If Sensitive Circumstances Exist Signature 2 DateSignature I i 1 1 x sDate 2 3 ir u' FBIHQ Approval 16 Unit Chief' lf Sensitive Circumstances Exist Signature Date COPY 4