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rest Warrant. if issued Copy of Complaint. Information. or Indictment. ircompleted 0 Copy of Deuiner(s). if issued O Copy of Writ. if applicable K Correctional facility discharge papers. if applicable K Correctional facility prisoner receipt. if applicable o Correctional facility medical summary. if appli
TTIC;N:;, smiko• ; 4 eustatiknoi by die USMS ionise Officer Sections ii AG ill are to be completed by the prisoner. Section may be completed by die USMS Intake Officer if the prisoner is unable • or unwilling, but Section HI must be signed by the prisoner. If prisoner refuses to sign. note that in the signature bl
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
to me while in the custody of the United States Marshals Service, and for infectious disease clearances. Signature of Prisoner Date Signature of USMS Intake Officer Date Original—Prisoner File Copy to District File Copy Upon Transfer Form USM-552 Est. 6/98 SDNY_TN_00020917 EFTA00140914 Repository Inquir
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
to me while in the custody of the United States Marshals Service, and for infectious disease clearances. Signature of Prisoner Date Signature of USMS Intake Officer Date Original--Prisoner File Copy to District File Copy Upon Transfer Rem USM-552 Est. 6/98 SONY N1T_00000217 EFTA00140902 Message Detail
Entities connected to both K Correctional and USMS Intake Officer
Prisoner Services Division
ORGANIZATION
Department of Justice
ORGANIZATIONK SAM
ORGANIZATIONthe Office of Interagency Medical Services
ORGANIZATIONDistrict File
ORGANIZATIONBooking Package
ORGANIZATIONLocation/Facility of Arrest
ORGANIZATIONK Separation
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
Michael C.Green
PERSON