EFTA01301662.pdf

-1 U.S. Department of Justice -Th UNCLASSIFIED//FOR OFFICIAL USE ONLY / United States Marshals Service FORM USM-78 I ARREST SHEET BIOGRAPHICAL INFORMATION Last name First name Middle initial Suffix Maxwell Ghislaine N DOB 14 4, DD ',WY' Subject address 12/25/1961 338 East Washington Rd. Bradford, New Hampshire Language Country of birth State Mother's country of birth Father's country of birth English France France Czechia Race Weight :lbs Sex Hair color Eye color Height :Ceti Height :liithe,1 White 142 Female BLK BRO 5 7 UCN ICEO rii,nitom I USMS Number FID Alien number SSN A000000000 CASE INFORMATION Court case number Warrant number OFFICE 20 CR 330 MISC v Sealed case ✓ High profile case Arresting agent last name Arresting agent first name Arrest location 338 East Washington Rd. Bradford, New Hampshire Arresting agent email address (must use a .gpv adds-sl Arresting agent phone Arresting agency ORI FBI SUBJECT INFORMATIOE Medical condition Mental condition Wasfclid the subject Drug usage in the past 24 Hrs. Coughing Thoughts of suicide Assaultive on arrest? Coughing up blood Thoughts of hurting yourself In possession of a weapon? Gang affiliations Night sweats Thoughts of hurting others Have martial arts training? r Yes rz No °Suspected Unexplained fever Known someone who Attempted to escape Separatees has committed suicide after arrest? Unexplained weight loss Experienced and recent loss of a family member or close friend CONFIDENTIALITY NOTICE: This report contains unclassified information of a sensitive, proprietary, health data or personally identifiable information (Pie which must be protected against release to unauthorized individuals and is the property of the U.S. Marshals Service. All emails, including all attachments, containing PII must be encrypted. Neither it nor its content may be disseminated outside the agency or personnel to which loaned without prior U.S. Marshals Service Authority. It is to be maintained, distributed, secured and disposed of in a manner that will protect the information against unauthorized disclosure and in accordance with The Privacy Act of 1974,5 USC § 552a. SDNY_GM_001661112 irn= PAGE I MCC, UNCLASSIFIED//FOR OFFICIAL USE ONLY / FORM USM-T8 EFTA_00189787 EFTA01301662  U.S. Department of Justice UNCLASSIFIEW/FOU 0 United States Marshals Service / FORM USM-78 I ARREST SHEET ARREST INFORMATION Arrest date int/so/mil Was the subject housed in a jail or medical facility? Subject had property on arrest 07/02/2020 OJail °Medical @No OYes 0 No 0 No, property retained by arresting agent If answered jail or medical facility, fill the designated fields below: Facility name Facility address Admit Date Release Date NCIC Offense Code Remarks Enticement of Minor for Prostitution - 6409 Conspiracy NCIC Offense Code Remarks Enticement of Minor for Prostitution - 6409 NCIC Offense Code Remarks Transport Interstate for Sexual Activity - 3622 Transportation of minors NCIC Offense Code Remarks Transport Interstate for Sexual Activity - 3622 Conspiracy to transport NCIC Offense Code Remarks Perjury - 5003 NCIC Offense Code Remarks NCIC Offense Code Remarks NCIC Offense Code Remarks NCIC Offense Code Remarks IMPORTANT: Prisoner IS NOT in USMS cus:odv ll1ILL DISTFOCT Calla SUBMIT FORM rernal2C'd by the Magistrate Judge. THE U.S. MARSHAL SERVICE DOES NOT ACCEPT ANY PERSONAL PROPERTY. NH CONCORD CLEAR FORM SDNY_GM_001661Rowycz= NG( 2 W1021 UNCLASSIFIED//FOUO FORM USM-78 EFTA_00189788 EFTA01301663