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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 EFTA00040006 LAW liNFORCEMIA Remarks: Da
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
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 OTHER Relationship First, MI Scar/Ma
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
E/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 SIGNIFICANT OTHER Relationship Co
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
Entities connected to both K Separation and K Correctional

Department of Justice
ORGANIZATIONK SAM
ORGANIZATIONPrisoner Services Division
ORGANIZATIONBooking Package
ORGANIZATIONUSMS Intake Officer
ORGANIZATIONthe Office of Interagency Medical Services
ORGANIZATIONLocation/Facility of Arrest
ORGANIZATIONDistrict File
ORGANIZATIONMedical Insurance Information
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATIONBROADWAY FBI NY
ORGANIZATIONLong Term Medical Conditions
ORGANIZATIONK Current
ORGANIZATIONK Eligible
ORGANIZATIONK Medical
ORGANIZATIONLeon Black
PERSONPrisoner Medical Records Release Form)-
ORGANIZATION
Julie K. Brown
PERSONAlbany
LOCATION
NEW YORK NY
LOCATION