FD-472 (Rev.10-20-2015) L C1 i authorize (Name) spe Ae Ned ak He hath and _Rericn She Ma of the Federal Bureau of Investigation, United States Department of Justice, to utilize the following Goital al that apply): Ab venody recor, 7B_X Transmit on or in the vicinity of my person; jerophone, or other recording device on or in the vicinity of my person; TB_x Recording device or other equipment to capture and record telephone communications, including conversations (voice, text messages, email, Inter, o other communications made or received over any telephone used by me; Utilize Closed Circuit Television (CCTV) or other video equipment located at toview (Cintas Neel ocation of Hotel or Deserpton of vehi es, or sate on consenting pany) “Daa conasting pany Grebe aaa obo EWE (16 eidcnes Kah area, MAT Teale) andlor Other (Specify): _ (ote: “ote cngiy ny ot leone! Same Tr mala fame esas fonmaneston, For consothitorzton monte comput communists eng mmaneaton ef computer ease feta he FDOT sor FD10T| spore) for the purpose of monitoring, viewing, listening to, an/or recording dny activity T may have with Best A Chectensen nd etre nyt nt ‘Name of Subject) which Imay have on or about _le | 1G 3.0-[7]__ sd comoving threat sch ine (Date) cither I revoke my permission or the FBI terminates the investigation. understand that I must bea party to any communication in order to record or monitor that communication. I therefore agree not to leave the recording or monitoring equipment unattended or take any action which is likely to result in the recording or monitoring of communications to wich [am not a party AND/ORInstall a Pen Register and/ot ‘Trap and Trace device in conjunction with the appropriate provider(s) of electronic or wite communications service and/or long distance carrier for the purpose of Identifying telephone numbers calling and being called by telephone number Tocated av/subscribed to by which is used by me, (Address) have given this writen permission to the above-named Special Agents voluntarily, and without threats or promises of any kind. Privacy Act Statement: Any information collected fom you on this form, along with any other device provided to you. for use on your person, vebicle, or other object, or for use atthe designated location lied on this form, will collet infomation about you, as authorized by law, and wall be used to support FBI activites. Your consat io providing information on this form and tothe subsequent collection of information inthe manner outlined on this form is ‘Voluntary. This information is maintined inthe sytem of records FBI-002, FBI Cental Recor System, and may be ile in acne ith pub tine ate em, Thee of PB-O02 nis ote wes maybe found on the FBI intemet ste a hip.