BOP legal visitation questionnaire for a federal inmate, undated

EFTA00057514¶

METROPOLITAN DETENTION CENTER¶

100 29\textsuperscript{TH} STREET¶

BROOKLYN, NEW YORK 11232¶

(718) 840-4200¶

METROPOLITAN CORRECTIONAL CENTER¶

150 PARK ROW¶

NEW YORK, NEW YORK 10007¶

(646) 836-6300¶

Dear Sir/Madam:¶

We are in receipt of your request that you, or a person whom you employ or supervise, be allowed to visit and correspond in relation to legal matters with Nikolai Niftalijev ,¶

Federal Register Number 87066-054 .¶

In order for such visiting or correspondence to be conducted, we must request that you, or your employee or your student, complete and sign the enclosed questionnaire. Please answer the questionnaire, and ensure that all sections are completed. In addition, we must request that the sponsoring attorney execute the Attorney’s Statement at the end of the questionnaire. Please return the form upon completion, either by regular or overnight mail.¶

BE ADVISED THAT APPLICATIONS WILL NOT BE ACCEPTED AT THE FRONT LOBBY OF THE INSTITUTION. APPLICATIONS SENT TO THIS OFFICE VIA FACSIMILE WILL BE DESTROYED UPON RECEIPT. ONLY ORIGINAL APPLICATIONS WILL BE PROCESSED.¶

The information supplied on this questionnaire may be used for investigative purposes in determining whether to grant this request to visit and correspond with inmates. The processing of the applications takes a minimum of 14 days from the date of receipt. It is your responsibility to contact the Legal Department to ascertain whether you, or your employee or student, will be allowed to visit or correspond with the above-referenced inmate.¶

Upon approval, the applicants admittance to enter will expire (1) year from the applicants date of approval. It is the applicant’s responsibility to reapply upon their expiration.¶

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GENERAL¶

This information is provided pursuant to Public Law 93-579, the Privacy Act of December 31, 1974.¶

PURPOSES & USES¶

The information you supply may be used as a basis for an investigation regarding your correspondence with Nikolai Niftalijev , Federal Register Number 87066-054 . In the process of conducting the investigation, the Bureau of Prisons may disclose the information to federal, state, or local law enforcement agencies.¶

EFFECTS OF NONDISCLOSURE¶

You are not required to supply the information requested on the attached questionnaire. If you do not furnish the information requested, the processing of your request will be suspended, and you will receive no further consideration. If you furnish only part of the information required, the processing of your request will be attempted; however, it may be significantly delayed. If the information withheld is found to be essential to processing your request properly, you will be so informed, and your request will receive no further consideration unless you supply the missing information. Although no penalties are authorized for failure to supply the requested information, failure to supply the information could result in your not being considered for or allowed admittance to the institution or correspondence privileges with the inmate in question.¶

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□ PARALEGAL* (See Page 5)¶

MITIGATION SPECIALIST (See Page 10)¶

□ INTERPRETER¶

□OTHER ___¶

PRIVATE INVESTIGATOR (See Page 9)¶

APPLICATION TO ENTER AN INSTITUTION OR CORRESPOND WITH A FEDERAL PRISONER AS THE REPRESENTATIVE OF A LICENSED ATTORNEY.¶

This form has three parts:¶

1. Questionnaire: This questionnaire is to be completed by each paralegal, legal assistant, clerk, student, interpreter, mitigation specialist or private investigator who seeks to enter an institution of the Federal Bureau of Prisons to visit or correspond with a federal prisoner as the representative of a licensed attorney. This application will not be processed unless this questionnaire with the original signature is received at the Legal Department.

2. Certification: Each person seeking to enter a federal institution to visit or correspond with a federal prisoner must sign the certification which follows the questionnaire.

3. Attorney’s Statement: The licensed attorney sponsoring you must sign the sponsoring statement. This application will not be processed if the Attorney’s Sponsoring Statement is not signed.

QUESTIONNAIRE¶

NOTE: Answer all questions. If a question does not apply to you, write “Not Applicable” in the space provided for the answer.¶

1. Name: JOSEPH F. O’BRIEN

A: Any alias or other name ever used:¶

Name: NOT APPLICABLE When Used: NOT APPLICABLE¶

2. A. Social Security Number:___

B. Date of Birth:___ C. Place of Birth:___¶

D. Sex:___ E. Race:___¶

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3. A. Present Residential Address:___

B. Length of time at this address: 1 year¶

C. Home telephone number:___¶

D. List all residential addresses (including street and number, city and state) for the last five (5) years and dates you resided at each address:¶

4. A. Present Place of Employment: Joe O’Brien clients, lnc

I. Name of immediate supervisor: self employed¶

II. Employer’s business address: [Blank] [Blank]¶

III. Employer’s telephone number: ___¶

IIII. Dates of Employment: ___1991-¶

B. List all previous employers for the past five (5) years, including employers’ addresses and dates of your employment with each employer:¶

5. A. List all schools, universities, or other educational institutions attended from grade

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*B. Paralegal entrance privileges are ONLY extended to paralegals in the employ of the sponsoring attorney, not self-employed paralegals who are consulted by attorneys.¶

Paralegal applications require the applicant A) be a current law school student or graduate B) provide a copy of their paralegal certificate or C) have a minimum of (6) months experience as a paralegal working with their sponsoring attorney AND provide a letter from the sponsoring attorney stating the applicant’s duties.¶

6. Have you ever been convicted of ANY criminal offense? NO

If so, complete the following. You may exclude any convictions for minor traffic violations (fine of $150.00 or less)¶

7. Have you ever been confined in any jail, prison or penal institution? NO If so, complete the following:

Type of Institution¶

Location¶

(State, Federal, Municipal County)¶

Dates of Confinement¶

NOT APPLICABLE¶

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8. Have you ever been charged with a criminal offense? If yes, please briefly summarize circumstances and legal disposition of the case.

NO¶

9. A Have you ever been denied permission to visit or correspond with an inmate by an institution within the Federal Bureau of Prisons (social or legal)?

$$NO$$¶

B. If so, state the institution(s), inmate(s) and date(s) of denial.¶

NOT APPLICABLE¶

10. Are you a citizen of the United States? A. Yes

If not, give the name of the country of which you are a citizen or subject: B.___¶

Alien Registration Number: C. ___¶

11. Are you a relative of or have a social relationship with the inmate(s) you are seeking to visit with at the MDC/ MCC? If yes, explain relationship.

NO¶

12. Are you currently on, or seeking to be placed on the social visiting list of any inmate(s) housed at a federal institution?

NO¶

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STATEMENT OF APPLICANT¶

I certify that I am authorized to act as the legal representative of Bennett M. Epstein who is a licensed member of the bar of the State of New York.¶

I request that I be allowed to interview and correspond with Nikolai Niftalijev,¶

Federal Register Number 87066-054, who is confined at the MDC/MCC.¶

I am aware of my responsibility as a representative of the above-named attorney and certify that I am able to meet this responsibility. I am also aware of the Bureau of Prisons’ Policy on Inmate Legal Activities and certify that I am able to and will adhere to the requirements of this policy. I pledge to abide by Bureau of Prisons regulations and institution guidelines.¶

I hereby certify that all of the information contained in this questionnaire is true and correct to the best of my knowledge. Furthermore, I understand that all information contained in this questionnaire may be investigated and verified through the use of federal, state and local authorities.¶

Applicant’s printed name: JOSEPH E O’BRIEN¶

Applicant’s signature: Joseph F. O’Brien¶

Date Completed:___10/5/19¶

Private Investigators must submit a copy of their Private Investigators Certificate and Private Investigator’s photo identification.¶

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STATEMENT OF SPONSORING ATTORNEY¶

I hereby certify that I am a licensed member of the bar of the State of New York ___¶

and that I employ or supervise Joseph O’Brien ___.¶

I authorize Joseph O’Brien to represent me and request that as my representative she/he be allowed to interview and correspond with Nikolai Niftalijev Federal Register Number 87066-054 who is currently confined at MDC Brooklyn/ MCC New York, I further certify that Joseph O’Brien is aware of the responsibility of her/his role as my representative and is able to meet this responsibility. I pledge that I will supervise my representative’s activities. I accept personal and professional responsibility for all acts of my representative which affect the institution, its inmates or staff.¶

Attorney’s printed name: Bennett M. Epstein¶

Address: 100 Lafayette Street, Suite 502, New York, NY 10013¶

telephone Number:___¶

Attorney’s Signature: /s/ Bennett M. Epstein¶

Date Completed: December 5, 2019¶

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PRIVATE INVESTIGATOR APPLICANTS¶

The following visiting procedures will be applied to Private Investigators entering the institutions:¶

Private Investigators on the approved list will be permitted to enter the institution without the accompaniment of their sponsoring attorney.¶

Private Investigators will be required to submit a statement of sponsoring attorney as well as a copy of their Private Investigator’s License EACH TIME THEY WANT TO VISIT ON BEHALF OF AN ATTORNEY OTHER THAN THE INITIAL SPONSORING ATTORNEY.¶

Your admittance to enter will expire one year from the date of your approval or upon the expiration of your private investigators license (which ever comes first).¶

Private Investigators will be permitted to bring pre-approved interpreters, if necessary.¶

Please be advised that it is the responsibility of the Private Investigator to make her/his sponsoring attorney aware of the above procedures. The enclosed Sponsoring Statement form can be reproduced locally.¶

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MITIGATION SPECIALIST/ DOCTOR APPLICANTS¶

The following visiting procedures will be applied to Mitigation Specialists entering this institution:¶

Mitigation Specialists/ Doctors on the approved list will be permitted to enter the institution without the accompaniment of their sponsoring attorney.¶

Mitigation Specialists/Doctors will be required to submit a court order along with the statement of sponsoring attorney EACH TIME THEY WANT TO VISIT ON BEHALF OF AN ATTORNEY OTHER THAN THE INITIAL SPONSORING ATTORNEY.¶

A new order must be produced for each inmate that the Mitigation Specialist/ Doctor seeks to correspond with, additionally, a new order must be produced when the mitigation specialist is renewing their application after expiration.¶

Mitigation Specialists/Doctors will be permitted to bring pre-approved interpreters, if necessary.¶

Mitigation Specialists/ Doctors must schedule visits by faxing a copy of the order and a letter specifying the date and time requested. The letter should include the inmate’s name and register number. The request needs to be faxed to the respective Legal Department for the institution you need to visit.¶

Please be advised that it is the responsibility of the Mitigation Specialist/ Doctors to make her/his sponsoring attorney aware of the above procedures. The enclosed Sponsoring Statement form can be reproduced locally.¶

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ATTACHMENT B¶