LAW ENFORCENIENT SENSITIVE

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) 0 Custodial Arrest (from a correctional:detention facility) EISA-lit Used Must provide cop) anPSI Aern.e-.7- Itettee4" .-r- K Prim Federal Arrest or Saleheeper Register n: K Safekeeper Location: MOGI( HID U INFORM fins. Last Name: Sex: F O Transgender Mir: 6 Fa_ frlEyts: eiv i t City of Birth: e tA/ I Srate/Coun ry of Birth: IState ION: First Name: Pregnant: ID Y lkight: Cr i FBI N: Resident Address/(10/StatettIP: 9 4-4, l omy Phone: Cell Phone: C %gent,: Aiy Agent Last Name: Agent Phone N: Location/Facility of Arrest: Court Docket Al Middle Name: Race: Ai Weight lecrl DOB: Ogn Citizenship t rarilif IMien : SSN /602 111 Charge Description SeYleigentil,/ Title/Code Agency ORI: 7 / 4/ew -71-17 ofdo ,e-r terey,./ ea p Al SA(s) Assigned: NC IC 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 K 1" Medical clearance by a licensed physician: ION K 1' Is Defendant under the influence of drugs or alcohol: 11N O languages - English: Limited Other Language: 'N K V • List Security Cautions: C min or former military I or former public official C bgiblc for diplomatic immunity O Threat to witness ifkserihe &km/ K Current or fonnerlAi'corrections K Assault on kfitorrections K Leadership role K CI (Describe befoul VIES Page I or3 O Current or limner intelligence K SAM subject or candidate O Separation needs rnesolhe halm) O other ilkscribt. liehnt.) Form USsa-312 Rev 11117 S0NY_GM_00173133 EFTA_00194788 EFTA01305099 ---PAGE BREAK--- 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 ! \ III I I DI( I(. \ \ I III III Relationship I Last Name First, MI Resident Address. City. State. Register # ZIP Code Phone 1Itl.• Scar/ilarkfTattoo (Specify) Location Description N I lilt I I • Vehicle leer Make Model Color(%) Vehicle Style State and Plate 0 Registration Date YIN I I( F. \SI ,: I icense Number 'License State MISUI.I.I.tNI'O1 • NI "I RI \Iiseellaneous Number Occupation: Employment Address: Start Date: Type (Sere t gram Jrninknen ma or type Wind 1 End Date: Remarks tegnivudantite•rtemory. etc.) Point of Contact: Aar crniA. Phone: I I\\\I Bank Name Account Type Account 'Branch Address Phone # MIMI \It\ fr B nett 1 Rank lEntry 'Discharge Date Date Discharge Type Military Oteupation Remarks RI. \ I \ Irks Additional Information/Remarks/Continuation: PROM Defendant Risks: •Retpdres yentas Its below O Escapee O Planned Murder o Organized Crime' O Protected Witness O International Terrorist O Domestic Terrorist O Gang Member O Significant Criminal I listory K Multiple Defendants O Death Penalty Case li tES Page? or3 Set Offender: O Angst K Registered O Conviction O Regimralion Form uSid.312 Rev 11/17 SDNY_GM_00173134 EFTA_D0 94789 EFTA01305100 ---PAGE BREAK--- LAW ENFORCEMENT SENSITIVE. Criminal History (Saesfrom dropriown menu or ore offmne below) Arrest (affliction (N) Rena pks 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. a minimum 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 For eirresdng Weer Only 4 USM-3I 2 (Personal I lima,- of I>efendant) Medical clearance (Rom licensed ph)skirad. if TICIX&W) opy of Arrest Warrant. it' issued Copy of Complaint. Information. or Indictment. if completed K Copy of (Maine/Isl. Jr issued K Copy of Writ. if applicable K Correctional facility discharge papers. if applicable K Correctional facility prisoner receipt. if applicable • Correctional facility medical summary. if applicable Prepared By - Name: Agency: Agra6 L- nfig.2 7X Teirl i fone Date: 7 elf 77)2*, /2ii/)7 A e/a 66),e0149 ARRESTEE PROCESSING CIIIX'KLIST For ISMS Personnel Only O Confirm all arresting agent documentation is completed and inserted into prisoner's file CSNI-3 I3 (Personal I I istor) of Deft:Wan) - revicn ed. signodand distal hr bitoAe In St/ DEO SAI-552 (Prisoner Medical Records Release Fotnil • Cluragsled signed ono/ anal by imitate 1)1 .St! l)t() E3 1 SNI•l8 (Federal Prisoner Property Receipt). vionplein i signed and dated by intake 1 it St1 K USM-40e-ll (Prisoner Remand) - lassoed murprivonce s file K USNI-I30 (Prisoner Custody Alen Notice). if applicable - Interred hue prisoner's ffle O EIS-249 (Fingerprint ('ard)- printed and inserrecl iron prisoneeclik O Prisoner Photograph (from !Woking Package) - integrate/ ilk Reviewed By: Badge N: I Date: U. LES Page 3 of 3 Form USM-312 Rev 11/17 SDNY_GM_00 173135 EFTA_00194790 EFTA01305101