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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
est Warrant. if issued Copy of Complaint. Information. or Indictment. if completed O Copy Of Uletainens). if issued O Copy of Writ. if applicable K Correctional facility discharge papas. if applicable O Correctional facility prisoner receipt. ilapplicable K Correctional facility medical summary. if applicab
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
t Warrant, if issued K Copy of Complaint, Information, or Indictment. if completed K Copy of Detainer(s), if issued K Copy of Writ, if applicable K Correctional facility discharge papers. if applicable K Correctional facility prisoner receipt. if applicable K Correctional facility medical summary. if applic
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
t Warrant, if issued O Copy of Complaint, Information, or Indictment, if completed O Copy of Detainer(s), if issued O Copy of Writ, if applicable K Correctional facility discharge papers, if applicable O Correctional facility prisoner receipt, if applicable K Correctional facility medical summary, if applic
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 EFTA
est 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 appli
Entities connected to both K SAM and K Correctional
Prisoner Services Division
ORGANIZATION
Department of Justice
ORGANIZATIONLocation/Facility of Arrest
ORGANIZATIONK Separation
ORGANIZATIONthe Office of Interagency Medical Services
ORGANIZATIONDistrict File
ORGANIZATIONBooking Package
ORGANIZATIONArrest Warrant
PERSONCopy of Complaint
ORGANIZATIONUSMS Intake Officer
ORGANIZATIONMedical Insurance Information
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATIONK Safekeeper Location
ORGANIZATIONBROADWAY FBI NY
ORGANIZATIONLong Term Medical Conditions
ORGANIZATIONK Current
ORGANIZATIONK Eligible
ORGANIZATIONK CI
ORGANIZATIONK Medical
ORGANIZATIONLeon Black
PERSON