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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
esident Address/City/State/ZIP Home Phone: Agent Last Name Marital Status: Single Agency ORI: NYFBINY00 Arrest Date: 11/19/2019 Agent Phone #: Location/Facility of Arrest: 290 BROADWAY FBI NY Court Docket #: CR AUSA(s) Assigned: NCIC Code Charge Description Title/Code MAKING FALSE STATEMENTS 18 USC 1001 CONSP
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
of Birth: Citizenship USA FBI #: Slate ID#: Resident Address/City/State/ZIP: Home Phone: Agency: FBI Agent Last Name Agent Phone Cell Phone Location/Facility of Arrest: 290 BROADWAY FBI NY Court Docket IS: CR AUSA(s) Assigned: Alien It: First Name SSN: Marital Status: Single Agency ORI: NYFBINY00 Arrest D
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
nt: 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,/
Entities connected to both K SAM and Location/Facility of Arrest
K Correctional
ORGANIZATION
Department of Justice
ORGANIZATIONBooking Package
ORGANIZATIONPrisoner Services Division
ORGANIZATIONK Separation
ORGANIZATIONK Safekeeper Location
ORGANIZATIONthe United States Marshals Service
ORGANIZATIONArrest Warrant
PERSONCopy of Complaint
ORGANIZATIONUnited Slates Marshals Service
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONUSMS Intake Officer
ORGANIZATIONthe Office of Interagency Medical Services
ORGANIZATIONDistrict File
ORGANIZATIONMedical Insurance Information
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATIONBROADWAY FBI NY
ORGANIZATIONLong Term Medical Conditions
ORGANIZATIONK Current
ORGANIZATIONK Eligible
ORGANIZATION