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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"
Moo/ 0 Current or former I.I. corrections K Assault on LI: corrections K Leadership mk O Ci /Describe below, El Current or runner intelligence K SAM subjr:ct or candidate K Separation weds ilktecrine Mott I K Other !Describe helm.; Title/Code TES Page I or 3 Form USM-312 Rev 11/17 EFTA0004
2 mentions1 same-page
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LAW ENFORCEMENT SENSITIVE U.S. Department of Justice United Slates Marshals Service Personal History of Defendant Taken into Federal custody by the following: IS) Street Arrest (not from a correctio
Last Name Current or former LE/corrections K Assault on LE/corrections K Leadership role K CI (Describe below) K Current or former intelligence K SAM subject or candidate K Separation needs (Describe below) K Other (Describe below) ASSOCIATES / CO-DEFENDANTS / RELATIVES CHILDREN SIGNIFICANT OTHE
2 mentions1 same-page
Page ?Same page
LAW ENFORCEMENT SENSITIVE U.S. Department of Justice United States Marshals Service Personal History of Defendant Taken into Federal custody by the following: is Street Arrest (not from a correction
rst, MI Current or former LE/corrections Assault on LE/corrections Leadership role CI (Describe below) Remark K Current or former intelligence K SAM subject or candidate K Separation needs (Describe below) K Other (Describe below) Date of Birth ASSOCIATES / CO-DEFENDANTS / RELATIVES / CHILDREN
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Mutual Connections (29)
Entities connected to both Department of Justice and K SAM
United States
LOCATION1,116 w/ Department·2 w/ K
LB
Leon Black
PERSON746 w/ Department·2 w/ K
Julie K. Brown
PERSON448 w/ Department·2 w/ K
Albany
LOCATION72 w/ Department·2 w/ K
NEW YORK NY
LOCATION68 w/ Department·2 w/ K
the United States Marshals Service
ORGANIZATION32 w/ Department·2 w/ K
Prisoner Services Division
ORGANIZATION11 w/ Department·3 w/ K
the Office of Interagency Medical Services
ORGANIZATION9 w/ Department·2 w/ K
AW
Arrest Warrant
PERSON7 w/ Department·2 w/ K
Copy of Complaint
ORGANIZATION6 w/ Department·2 w/ K
K Correctional
ORGANIZATION4 w/ Department·4 w/ K
K Assault
ORGANIZATION5 w/ Department·2 w/ K
District File
ORGANIZATION5 w/ Department·2 w/ K
Booking Package
ORGANIZATION5 w/ Department·2 w/ K
Location/Facility of Arrest
ORGANIZATION3 w/ Department·3 w/ K
K Separation
ORGANIZATION3 w/ Department·3 w/ K
United Slates Marshals Service
ORGANIZATION4 w/ Department·2 w/ K
New York State Division of Criminal Justice Services
ORGANIZATION4 w/ Department·2 w/ K
Medical Insurance Information
ORGANIZATION4 w/ Department·2 w/ K
Michael C.Green
PERSON3 w/ Department·2 w/ K