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red for the privilege with me. it will be neeemary for you to fill out the questionmare and release form below and return it to the !Mowing address: Metropolitan Correctional Canter 150 Park Row, New York, H.Y. 10007 Attn: Counselor ?nit 7 South lou are not required to supply the information requested. Flowerer. if yon do sot
location(s): 14. Driver's License No. and State of Issuance: Artregel arras TO =SP= 1,701.10l. ICU I hereby authorize release to the Warden of: The Metr000litan Correctional Center. N.Y any record of criminal offense for which I have beet arrested anciar coasted. and any information rested to those convict:as. ••FORNIS RETURNE
om J Pm roll FRP Plan Informalloa FRP Plan Type Expected Amount Everted Rate Outside Source Funds Account Balances Account Balance: 5198.42 Pre-Release Balance: $0.00 Debt Encumbrance: 50.00 SPO Encumbrance: $0.00 Other Encumbrances: 50.00 Outstanding Negotiable Instruments: $0.00 https://10.33.56.
G0000 TRANSACTION SUCCESSFULLY COMPLETED WRK SUICIDE OR UNASSG SUICIDE OR EFTA00049170 Attachment C Date: 7 Visiting 5267.06F y 17,2009 Metropolitan Correctional Center - New York A- tty Room / Visiting Room inventory trililSt• Nine' . .,-- Nigiii:10 Unit --:‘ .ft5r i' ' Ttme • A* . C Pitt ,. e,•-: C ES ' S 153/9 A51/
V Payroll Outside Source Funds FRP Plan Information FRP Plan Type Expected Amount Expected Rate Account Balances Account Balance: $566.27 Pre-Release Balance: $0.00 Debt Encumbrance: $0.00 SPO Encumbrance: S0.00 Other Encumbrances: $0.00 Outstanding Negotiable Instmments: $0.00 hups://10.33.56.10
(C} I I ,. l : • I I (b)(6); (b}(7}(C} (b}(6}; (b)(7)(C) (b)(6), (b}(7}(C} I Attachment C Visiting NYM 5267.06F July l?,°2009 r Metropolitan Correctional Center • New York 7/. Da11v Attv. Room I Visitinq Room Inventory Date: d .. .JJ I I '-f -~~-f-1---j---- lb)(6) (b)(7)(C) v 10 11 12 13 14 , I r" - - . 1
0 Payroll FRP Plan Information fv Outside Source Funds FRP Plan Type Expected Amount Expected Rate Account Balances Account Balance: $566.27 Pre-Release Balance: S0.00 Debt Encumbrance: S0.00 SPO Encumbrance: S0.00 Oilier Encumbrances: S0.00 Outstanding Negotiable Instrumenis: S0.00 https://10.33 .5
on(s) : 14. Driver's License No. and State of Issuance: A3/4”7:SORST.ATICat TO RELEASE 12CFOROSPiTION I hereby authorize release to the Warden of: The Metropolitan Correctional Center. N.Y any record of criminal offenses for which I have been arrested and or convicted. and any information related to those convictons. "FORMS RETUR
ation FRP Plan Type Expected Amount Expected Rate Outside Source Funds Cgmainscaustisaggs I acrai . Account Balances Account Balance: S198.42 Pre-Release Balance: $0.00 Debt Encumbrance: $0.00 SPO Encumbrance: $0.00 Other Encumbrances: 50.00 Outstanding Negotiable Instruments: 50.00 hups://10.33.56.1
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