Police record, 2019-11-19

LAW ENFORCEMENT SENSITIVE¶

Taken into Federal custody by the following:¶

• Street Arrest (not from a correctional/detention facility)
• Custodial Arrest (from a correctional/detention facility)

□ Writ Used (Must provide copy of writ) □ Prior Federal Arrest or Safekeeper - Register #: ___ - □ Safekeeper Location: ___¶

BIOGRAPHICAL INFORMATION¶

Last Name: THOMAS First Name: MICHAEL Middle Name:¶

Sex: ☐ M ☐ F ☐ Transgender Pregnant: ☐ Y ☐ N Race: B-Black/Black Hispanic¶

Hair: BLACK Eyes: BROWN Height: ___ Weight: ___ DOB: ___¶

City of Birth: State/Country of Birth: Citizenship: USA¶

FBI #: State ID#: Alien #: SSN:¶

Resident Address/City/State/ZIP:¶

Home Phone: Cell Phone Marital Status: Single¶

COURT CASE¶

Agency: FBI Agency ORI: NYFBINY00¶

Agent Last Name: First Name:¶

Agent Phone #: Arrest Date: 11/19/2019¶

Location/Facility of Arrest: 290 BROADWAY FBI NY¶

Court Docket #: ___ CR AUSA(s) Assigned:¶

OFFENSE¶

NCIC Code Charge Description Title/Code¶

MAKING FALSE STATEMENTS 18 USC 1001¶

CONSPIRACY TO MAKE FALSE STATEMENTS 18 USC 371¶

Known Detainers/Warrants: ☑ N ☐ Y - Agency: (Must provide a copy of any detainers)¶

CAUTIONS AND MEDICAL¶

Long Term Medical Conditions (e.g., heart problems, diabetes, asthma, tuberculosis, HIV, AIDS, hepatitis, etc.): ☑ N ☐ Y¶

Psychiatric/Emotionally Disturbed (e.g., mental health concerns, suicidal, etc.): ☑ N ☐ Y¶

Injuries/Medical Ailments/Post-Op Recovery: ☑ N ☐ Y¶

Do the above conditions require:¶

Medical attention? ☑ N ☐ Y¶

Medication? ☑ N ☐ Y¶

Medical clearance by a licensed physician: ☑ N ☐ Y¶

Is Defendant under the influence of drugs or alcohol: ☑ N ☐ Y¶

Languages - English: ☑ N ☐ Y Limited¶

Other Language: ☑ N ☐ Y - List: ___¶

U/LES¶

Form USM-312	Rev. 11/17

Page 1 of 3¶

SDNY_MT_00000212¶

EFTA00140897¶

LAW ENFORCEMENT SENSITIVE¶

Security Cautions:
☐Current or former military	☒Current or former LE/corrections	☐Current or former intelligence
☐Current or former public official	☐Assault on LE/corrections	☐SAM subject or candidate
☐Eligible for diplomatic immunity	☐Leadership role	☐Separation needs(Describe below)
☐Threat to witness(Describe below)	☐CI(Describe below)	☐Other(Describe below)

Remarks:¶

ALIASES
	ALIAS Last Name	ALIAS First, MI	Remark	Date of Birth	SSN	State Driver's License

ASSOCIATES / CO-DEFENDANTS / RELATIVES / CHILDREN / SIGNIFICANT OTHER¶

Relationship	Last Name	First, MI	Register #	Resident Address, City, State, ZIP Code	Phone
Co-Defendant	TOVA	NOEL	-

MARKS¶

Scar/Mark/Tattoo(Specify)	Location	Description

VEHICLES¶

Vehicle Year	Make	Model	Color(s)	Vehicle Style	State and Plate #	Registration Date	VIN

LICENSES¶

License Number	License State

MISCELLANEOUS NUMBERS¶

Miscellaneous Number	Type(Select from dropdown menu or type below)	Remarks(e.g., Issuing State or Country, etc.)

OCCUPATIONS¶

Employment Address: 150 PARK ROW NEW YORK NY			Phone:
Start Date:	End Date:	Point of Contact:

FINANCIAL¶

Bank Name	Account Type	Account #	Branch Address	Phone #

MILITARY¶

Branch	Rank	Entry Date	Discharge Date	Discharge Type	Military Occupation	Remarks

REMARKS¶

Additional Information/Remarks/Continuation:¶

U/LES¶

Form USM-312	Rev. 11/17

Page 2 of 3¶

SDNY_MT_00000213¶

EFTA00140898¶

LAW ENFORCEMENT SENSITIVE¶

PROFILE¶

Defendant Risks: Requires remarks below¶

• Escapee
• Organized Crime*
• International Terrorist
• Gang Member*
• Multiple Defendants
• Death Penalty Case

Sex Offender:¶

• Arrest
• Conviction
• Registered
• Registration Violation

• Add History

Criminal History (Select from dropdown menu or type offense below)¶

Arrest (#)	Conviction (#)
NONE

Remarks (e.g., name of gang or criminal organization, etc.):¶

• Money Launderer
• Kingpin
• Violent Offender

INTERNET SOURCE¶

Internet Source	Remarks (e.g., email address, website address, username, etc.)

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NOTICE TO ARRESTING AGENTS: As a courtesy, the USMS may temporarily hold an arrestee received by non-USMS personnel in the cellblock until the arresting agent(s) make arrangements for the prisoner’s initial appearance before a United States Magistrate. A prisoner must remain the responsibility of the arresting agency until remanded to the custody of the USMS by the courts. When a courtesy host is allowed by the USMS to be housed in a USMS cellblock, a minimum of one agent from the arresting agency must be available to respond to the cellblock in order to address any issues with their prisoner (e.g., medical, disciplinary). If the arresting agency refuses to comply with USMS procedures, the courtesy hold may be refused. Meals are not provided by the USMS, and remain the responsibility of the arresting agent(s).¶

ARRESTEE PROCESSING CHECKLIST¶

For Arresting Officer Only¶

• USM-312 (Personal History of Defendant)
• Medical clearance (from licensed physician), if necessary
• Copy of Arrest Warrant, if issued
• Copy of Complaint, Information, or Indictment, if completed
• Copy of Detainer(s), if issued
• Copy of Writ, if applicable
• Correctional facility discharge papers, if applicable
• Correctional facility prisoner receipt, if applicable
• Correctional facility medical summary, if applicable

Prepared By - Name:¶

Agency: FBI/NYPD¶

Cell Phone: Date: 11/19/2019¶

ARRESTEE PROCESSING CHECKLIST¶

For USMS Personnel Only¶

• Confirm all arresting agent documentation is completed and inserted into prisoner’s file
• USM-312 (Personal History of Defendant) - reviewed, signed and dated by intake DUSM/DEO
• USM-552 (Prisoner Medical Records Release Form) - completed, signed and dated by intake DUSM/DEO
• USM-18 (Federal Prisoner Property Receipt) - completed, signed and dated by intake DUSM/DEO
• USM-40/41 (Prisoner Remand) - inserted into prisoner’s file
• USM-130 (Prisoner Custody Alert Notice), if applicable - inserted into prisoner’s file
• FD-249 (Fingerprint Card) - printed and inserted into prisoner’s file
• Prisoner Photograph (from Booking Package) - printed and inserted into prisoner’s file

Reviewed By:¶

Badge #: Date:¶

U/LES¶

Form USM-312	Rev. 11/17

Page 3 of 3¶

SDNY_MT_0000214¶