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

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

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