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'I ? L 4 ! ! ! EFTA00040029 llSr.1-285 is'a 5-part form. Fill nut the form and print 5 cupies. Sign as needed and route as specified below. U.S. Department of Justice Linked States Marshals Service PLAINTIFF UNITED STATES OF AMERICA ROCESS RECEIPT AND RETURN "Instructions for &Mee ofProcess by U.S. Mansital"
- PO pat170297, San Juan,PR 00936-8297 itaa 4MultiPan mApsite ' FuttitatkOle.«:+ Pharmacists= 888-290-64i 6 Pharmacy Claims: OptumRx PO Box 29044 Hot Springs, AR 71903 ' ry your card with you when you're at:a, _et your hospital or doctor see your card when you ncu hospital, medical, or health services un
ss: Witness: Time: to: 11pm FD-395 (Revised 11-05-2002) Page 1 of. 1 FEDERAL BUREAU OF INVESTIGATION EFTA00257769 LAW ENFORCEMENT SENSITIVE U.S. Department of Justice United Slates Marshals Service Personal History of Defendant Taken ' to Federal custody by the following: Street Arrest (not from a correctional/
03740800 PR MAPFRE - PO Box70297, San Juan, PR 00936.8297 •41 -47v1M1Yli MAPFRE Pharmacists: 888-290-5416 Pharmacy Claims OplumRx PG Sex 29044 Hot Springs, AR 71903 You may be asked to snow the tare when you gel health care services Only give your personal Medicare information to health carp provider
heir. investigation. Date Signature Witness EFTA01699596 This is to certify that on at Special Agents of the Federal Bureau of Investieation. U. S. Department of Justice. conducted a search of I certify that nothing was removed from my custody by Special Agents of the Federal Bureau of Investigation, U. S. Departme
Box70297. San Juan, PR 00936-8297 ya. Sw Stay multipari MAPFRE cin.Rfct-s--A Pharmacists: 888-290-5416 Pharmacy Claims: OptumFtx PO Box 29044 Hot Springs, AR 71903 Call anytime to speak with a Nurse 1. Carry your card with you when you're away from home 2. Let your hospital or doctor see your card
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