EFTA01305099.pdf

LAW ENFORCENIENT SENSITIVE .S. Department of Justice I:nited Stales Slarshals &nice Personal History of Defendant Taken Federal custody by the following: Street Arrest (not from a coweetionaidetention facility) EISA-lit Used Must provide cop) anPSI Aern.e-.7- Itettee4" .-r- 0 Custodial Arrest (from a correctional:detention facility) ❑ Prim Federal Arrest or Saleheeper Register n: ❑ Safekeeper Location: MOGI( HID U INFORM fins. Last Name: First Name: Middle Name: t rarilif Sex: F O Transgender Pregnant: ID Y Race: Ai Mir: 6 Fa_ frlEyts: eiv i t lkight: Cr i Weight lecrl DOB: Ogn City of Birth: e tA/ I Srate/Coun ry of Birth: Al Citizenship FBI N: I State ION: IMien : SSN Resident Address/(10/StatettIP: 9 4-4, C /602 l omy Phone: Cell Phone: 111 %gent,: Aiy Agency ORI: Agent Last Name: Agent Phone N: 7 / Location/Facility of Arrest: ofdo ,e-r terey,./ ea p 4/ew -71 17 - Court Docket Al SA(s) Assigned: NCIC Code Charge Description SeYleigentil,/ Title/Code use 37/ Known Detainers/Ws cranes: - Agency: Must I:amides copy of any delainen) \I %ND Mull( \t. Long Term Medical Conditions ire.. heart pn•blrmh diabetes asthma. itahereoloxie. 111V. AIDS. htpsiili% N O Psychiatric/Emotionally Disturbed (en-menial health enerern...ukIdid. N Injuriesaledical Ailments/Post-Op Recovery:0i0 N' Do the above conditions rents re: Medical attention? N CI V Medication? N ❑ 1" Medical clearance by a licensed physician: ION ❑ 1' Is Defendant under the influence of drugs or alcohol: 11N O languages - English: Limited Other Language: 'N ❑ V • List Security Cautions: C min or former military ❑ Current or fonnerlAi'corrections O Current or limner intelligence I or former public official ❑ Assault on kfitorrections ❑ SAM subject or candidate C bgiblc for diplomatic immunity ❑ Leadership role O Separation needs rnesolhe halm) O Threat to witness ifkserihe &km/ ❑ CI (Describe befoul O other ilkscribt. liehnt.) VIES Form USsa-312 Page I or3 Rev 11117 S0NY_GM_00173133 EFTA_00194788 EFTA01305099  LAW liNFORCEME% r SENSITIVE. Remarks: v.] ALIAS Last Name 1 ALIAS Elem.MI ( mark Date of Birth ISSN Slate Driver's License \ ‘`‘I 1( \ I I `. () III.' \ RI ! \ I II I I DI( I(. \ \ I III III Resident Address. City. State. Relationship I Last Name First, MI Register # ZIP Code Phone 1Itl.• Scar/ilarkfTattoo (Specify) Location Description N I l ilt I I • Vehicle State and Registration leer Make Model Color(%) Vehicle Style Plate 0 Date YIN I I( F. \SI ,: I icense Number 'License State MISUI.I.I.tNI'O1 • NI "I RI \Iiseellaneous Number Type (Seretgram Jrninknen ma or type Wind Remarks tegnivudantite•rtemory. etc.) Occupation: Aar crniA. Employment Address: Phone: Start Date: 1End Date: Point of Contact: I I\\\I Bank Name Account Type Account 'Branch Address Phone # MIMI \It\ lEntry 'Discharge B nett fr 1Rank Date Date Discharge Type Military Oteupation Remarks RI. \ I \ Irks Additional Information/Remarks/Continuation: PROM Defendant Risks: •Retpdres yentasIts below Set Offender: O Escapee O Planned Murder O Angst O Conviction o Organized Crime' O Protected Witness ❑ Registered O Regimralion O International Terrorist O Domestic Terrorist O Gang Member O Significant Criminal I listory ❑ Multiple Defendants O Death Penalty Case li tES Form uSid.312 Page? or3 Rev 11/17 SDNY_GM_00173134 EFTA_D0 94789 EFTA01305100  LAW ENFORCEMENT SENSITIVE. Criminal History (Saesfrom dropriown menu or ore offmne below) Arrest (affliction (N) Renapks e.g.. name of gang or criminal organization. etc.): IV 0 Money Launderer 0 Kingpin 0 Violent Offender IsIll(S1 I "UI RI I Internet Source Reverts (e.g., small address, nchslte address. username. etc.) NOTICE TO ARRESTING AGENTS: As a courtesy. the USMS may temporarily hold an arrestee received by non-USMS personnel in the cellblock until the arresting agents) make arrangements for the prisoner's initial appearance before a United Slats Magistrate. A prisoner remains the responsibility of the arresting agency until remanded to the custody of the USMS by the courts. When a courtesy hold is allowed by the USMS to be housed in a USMS cellblock. minimum a of one agent from the arresting agency must be available to respond to the cellblock in order to address any issues with their prisoner (e.g.. medical. discipliner)) If the arresting agency refuses to comply with USMS procedures. the cosines) hold ma) be refused. Meals arc not provided b) the USMS. and remain the responsibility of the arresting agengsl. ARRESTEE PROCESSING CHECKLIST ARRESTEE PROCESSING CIIIX'KLIST For eirresdng Weer Only For ISMS Personnel Only 4 USM-3I 2 (Personal I lima,- of I>efendant) Medical clearance (Rom licensed ph)skirad. if TICIX&W) O Confirm all arresting agent documentation is completed and inserted into prisoner's file opy of Arrest Warrant. it' issued CSNI-3 I3 (Personal I I istor) of Deft:Wan) - revicn ed. signodand distalhr bitoAe In St/ DEO Copy of Complaint. Information. or Indictment. if completed SAI-552 (Prisoner Medical Records Release Fotnil • ❑ Copy of (Maine/Isl. Jr issued Cluragsled signedono/ anal by imitate 1)1 .S t! l)t() ❑ Copy of Writ. if applicable E3 1 SNI•l8 (Federal Prisoner Property Receipt). vi onplein i ❑ Correctional facility discharge papers. if applicable signedand dated by intake 1it St1 ❑ Correctional facility prisoner receipt. if applicable ❑ USM-40e-ll (Prisoner Remand) - lassoed murprivoncesfile • Correctional facility medical summary. if applicable ❑ USNI-I30 (Prisoner Custody Alen Notice). if applicable - Prepared By - Name: Interred hue prisoner's ffle Agency: Agra6 L- nfig.2 O EIS-249 (Fingerprint ('ard)- printed and inserrecl iron 7X prisoneeclik Teirl fonei Date:7 elf O Prisoner Photograph (from !Woking Package) - integrate/ ilk Reviewed By: Badge N: I Date: 77)2*, /2ii/)7Ae/a 66),e0149 U. LES Form USM-312 Page 3 of 3 Rev 11/17 SDNY_GM_00173135 EFTA_00194790 EFTA01305101