FBI 164-81, Vault Part 82 p. 390 (DB Cooper-36310), Form, serial SE 164-81-1A (as read from the transcript) — cooper.theunsolved.net/parts/Cooper-Part-82/pages/390
The scan is the source; the transcript is machine-generated from it.
FD-340 (REV. 6-24-65)
File No. 164-8-[illegible] (310)
Date Received ___________
From [guess: 10-4-90-] [illegible] (NAME OF CONTRIBUTOR)
__________ (ADDRESS OF CONTRIBUTOR)
__________ (CITY AND STATE)
By __________ (NAME OF SPECIAL AGENT)
To Be Returned [X] Yes [ ] No Receipt given [ ] Yes [X] No