4
Shared Docs
4
Same-Page
4 / 4
Mentions
if applicable - inserted into prisoner's file K FD-249 (Fingerprint Card) - printed and inserted into prisoner's file K Prisoner Photograph (from Booking Package) - printed and inserted into prisoner's file Reviewed By: Badge U: U/113 Page 3 of 3 Date: Form USM.312 Rev 11/17 SDNY_TN_00020914 EFTA0014
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
if applicable - inserted into prisoner's file K FD-249 (Fingerprint Card) - printed and inverted into prisoner's file K Prisoner Photograph (from Booking Package) - printed and inserted Into prisoner's file Reviewed By: Badge X: U/LES Page 3 of 3 Date: Form tISM-312 Rev. 11/17 SDNY_MT_00000214 EFTA00
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
, if applicable - inserted into prisoner's file K FD-249 (Fingerprint Card) - printed and inserted into prisoner'sfile O Prisoner Photograph (from Booking Package) - printed and inserted inm prisoner's file Reviewed By: Badge fl: Date: U/LES Page 3 of 3 Form USM-312 Rev. 11/17 EFTA00257772 AKAs: BP-
ry of Birth: Citizenship: FBI 4: State ID#: Alien : SSN Resident Address/City/StateTLIP: I tome Phone: Agency: Agent Last Name: Cell Phone Location/Facility of Arrest: 7 ec A eyw. 7°02 Agency ORI: First Name: Arrest Date: Court Docket N: CR Known Detainers/Warrants: 'ieao.CT, /ere/eye/ ea AUSA(s) Assigned
soner Custody Alert Notice). if applicable - ntreriestimurrlsoner's.file • EIN249 (Fingerprint Cud)• prixinkt% Jilt O Prisoner Photograph ( from Booking Package) • 101k41.11ki baffled finer prixonerIA file child %DAWN, MID Res iewed By: Badge M: I Date: U LES Pap: 3 of 3 Font USM-312 Rev ill17 USAO
State IDN: Alien : SSN: Resident Address/City/StaleTZIP: 9 a;„7.,Air , llome Phone Cell Phone: ell It I \NI Agt.er NY /en' Agent Phone N: Location/Facility of Arrest: Court Docket it: •e-trVOICKi AUSA(s) Assigned: /OO tat Status; Agency ORE OF FENN' Nr'IC Code barge Description ..SeYreAtenCfrinti 495( us
Entities connected to both Booking Package and Location/Facility of Arrest

Department of Justice
ORGANIZATIONPrisoner Services Division
ORGANIZATIONK Correctional
ORGANIZATIONthe Office of Interagency Medical Services
ORGANIZATIONK SAM
ORGANIZATIONUSMS Intake Officer
ORGANIZATIONDistrict File
ORGANIZATIONCopy of Complaint
ORGANIZATIONK Safekeeper Location
ORGANIZATIONArrest Warrant
PERSONFederal Bureau of Investigation - New York
ORGANIZATIONBROADWAY FBI NY
ORGANIZATIONY - Agency
ORGANIZATIONLong Term Medical Conditions
ORGANIZATIONK Current
ORGANIZATIONK Eligible
ORGANIZATIONK Medical
ORGANIZATIONLeon Black
PERSONPrisoner Medical Records Release Form)-
ORGANIZATION
Julie K. Brown
PERSON