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Jail record · March 2002

Blank MCC New York visiting application forms, March 2002 version

Standard Bureau of Prisons visiting application forms for MCC New York inmates, blank and filled with no specific names.Machine-written summary

EFTA00140959

2020-01577 #1

UNCLASSIFIED

Record Images

MAR 2002

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

Visiting Application

Metropolitan Correctional Center

150 Park Row

New York, N.Y. 10007

Date:___

RE:

Inmate Name and Registration number

Dear:

I am requesting that you be included among my approved visitors. In order to establish your suitability as a visitor, it may be necessary for institution officials to send an inquiry to an appropriate law enforcement or crime information agency to ascertain whether or not placing you on my list would present a management problem for the institution, or have other possible adverse effects. The information obtained will be used to determine your acceptability as a visitor. The Bureau of Prisons’ authority to request background information on proposed visitors is contained in Title 18 U.S.C. 4042.

In order for you to be considered for the privilege with me, it will be necessary for you to fill out the questionnaire and release form below and return it to the following address: Metropolitan Correctional Center

150 Park Row, New York, N.Y. 10007

Attn: Counselor Unit 7 South

You are not required to supply the information requested. However, if you do not furnish the information, 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 may be significantly delayed. If the information withheld is found to be essential to the processing of your request, you will be informed, and your request will receive no further consideration unless you supply the missing information. Although no penalties are authorized if you do not supply the information requested, failure to supply such information could result in your not being considered for admittance as a visitor. The criminal penalty for making false statements is a fine of not more than $250,000 or imprisonment for not more than five years or both (See 18 U.S.C. 101).

Sincerely, (Inmate Signature)

Forms Returned To The Inmate WILL NOT BE ACCEPTED

1. Legal Name2. Date of Birth3. Address(Including Zip Code)
4. Telephone Number(Including Area Code)5. Race and Sex of Visitor
6. Are you a U.S.Citizen? YesNo6a. If yes, provide Social Security No:___ 6b. If no, provide Alien Registration No:___ 6c. Provide Passport No:___ 6d. Provide a copy of Drivers License or Passport
7. Relationship to above-named inmate8. Do you desire to visit him/her? YesNo
9. Did you know this person prior to his/her current incarceration? YesNo
10. If the answer to #9 is yes, indicate the length of time you have known this person and where the relationship developed:

  1. If the answer to #9 is yes, indicate the length of time you have known this person and where the relationship developed.:

  2. Have you ever been arrested and/or convicted of a crime? If so, state the number, date, place, and nature of the arrest/s and/or conviction/s:

  3. Are you currently on probation, parole, or any other type of supervision? If so, state the name of your supervising probation/parole officer and the address and telephone no. where he/she can be contacted:

  4. Do you correspond or visit with other inmates? If so, indicate the individual(s) and their location(s):

  5. Driver’s License No. and State of Issuance:

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize release to the Warden of: The Metropolitan Correctional Center, N.Y. any record of criminal offenses for which I have been arrested and/or convicted, and any information related to those convictions.

**FORMS RETURNED TO THE INMATE

WILL NOT BE ACCEPTED**

Applicant’s Signature for Authorization to Release Information(Sign and Print Name)

(If applicant is under 18 years of age, signature of parent or guardian indicates consent of minor to visit inmate) If additional space is required, you may use the back of this form. (This form may be replicated via WP) To be filed in Inmate Central File, FOI Section 2

FOI EXEMPT/SENSITIVE BUT UNCLASSIFIED

UNCLASSIFIED

23 of 26

Page: 34 of 153 - 2020-01577 #1 Record Images (i3).pdf

SDNY_00017864

EFTA00140960

2020-01577 #1

UNCLASSIFIED

Record Images

DR-2049.ND4

MAR 2002

Visiting Application

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

Metropolitan Correctional Center

150 Park Row

New York, N.Y. 10007

Date:

RE:

Inmate Name and Registration number

Dear:

I am requesting that you be included among my approved visitors. In order to establish your suitability as a visitor, it may be necessary for institution officials to send an inquiry to an appropriate law enforcement or crime information agency to ascertain whether or not placing you on my list would present a management problem for the institution, or have other possible adverse effects. The information obtained will be used to determine your acceptability as a visitor. The Bureau of Prisons’ authority to request background information on proposed visitors is contained in Title 18 U.S.C. 4042.

In order for you to be considered for the privilege with me, it will be necessary for you to fill out the questionnaire and release form below and return it to the following address: Metropolitan Correctional Center

150 Park Row, New York, N.Y. 10007

Attn: Counselor Eklund, Unit 7 South

You are not required to supply the information requested. However, if you do not furnish the information, 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 may be significantly delayed. If the information withheld is found to be essential to the processing of your request, you will be informed, and your request will receive no further consideration unless you supply the missing information. Although no penalties are authorized if you do not supply the information requested, failure to supply such information could result in your not being considered for admittance as a visitor. The criminal penalty for making false statements is a fine of not more than $250,000 or imprisonment for not more than five years or both (See 18 U.S.C. 101).

Sincerely, (Inmate Signature)

Forms Returned To The Inmate WILL NOT BE ACCEPTED

1. Legal Name2. Date of Birth3. Address(Including Zip Code)
4. Telephone Number(Including Area Code)5. Race and Sex of Visitor
6.Are you a U.S.Citizen? YesNo6a.If yes,provide Social Security No:___ 6b.If no,provide Alien Registration No:___ 6c.Provide Passport No:___ 6d.Provide a copy of Drivers License or Passport

  1. Did you know this person prior to his/her current incarceration? ___Yes___No

  2. If the answer to #9 is yes, indicate the length of time you have known this person and where the relationship developed.:

  3. Have you ever been arrested and/or convicted of a crime? If so, state the number, date, place, and nature of the arrest/s and/or conviction/s:

  4. Are you currently on probation, parole, or any other type of supervision? If so, state the name of your supervising probation/parole officer and the address and telephone no. where he/she can be contacted:

  5. Driver’s License No. and State of Issuance:

  6. Do you correspond or visit with other inmates? If so, indicate the individual(s) and their location(s):

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize release to the Warden of: The Metropolitan Correctional Center, N.Y. any record of criminal offenses for which I have been arrested and/or convicted, and any information related to those convictions.

**FORMS RETURNED TO THE INMATE

WILL NOT BE ACCEPTED**

Applicant’s Signature for Authorization to Release Information(Sign and Print Name)

(If applicant is under 18 years of age, signature of parent or guardian indicates consent of minor to visit inmate) If additional space is required, you may use the back of this form. (This form may be replicated via WP) To be filed in Inmate Central File, FOI Section 2

FOI EXEMPT/SENSITIVE BUT UNCLASSIFIED

24 of 26

UNCLASSIFIED

Page: 35 of 153 - 2020-01577 #1 Record Images (i3).pdf

SDNY_00017865

EFTA00140961

2020-01577 #1

UNCLASSIFIED

Record Images

TRULINCS Contact Request Form

U.S. DEPARTMENT OF JUSTICE

REGISTER NUMBER:DATE:
INMATE NAME:UNIT:

CONTACT 1

All fields are required.

Action: Add Delete Edit
Contact's First Name:(Maximum 10 characters)
Contact's Last Name:(Maximum 19 characters)
Phone 1: （ ）
Phone 2: （ ）

Relationship:

  • Attorney
  • Business
  • Children
  • Clergy
  • Friend
  • Other Relation
  • Parent
  • Sibling
  • Spouse

CONTACT 2 (Optional)

Language of Contact:

☐ English ☐ Spanish

Contact's First Name: (Maximum 10 characters)
Contact's Last Name: (Maximum 19 characters)
Postal Address
Country:
Zip Code:
City:
State:
Re:
Address Line 1:
Address Line 2:
Address Line 3*:
Phone 1: （ ）
Phone 2: （ ）

Relationship:

  • Attorney
  • Business
  • Children
  • Clergy
  • Friend
  • Other Relation
  • Parent
  • Sibling
  • Spouse

Language of Contact:

☐ English ☐ Spanish

Postal Address
Country:
Zip Code:
City:
State:
Re:
Address Line 1:
Address Line 2:
Address Line 3*:
  • For international labels only

UNCLASSIFIED

25 of 26

Page: 36 of 153 - 2020-01577 #1 Record Images (i3).pdf

SDNY_00017866

EFTA00140962

2020-01577 #1

UNCLASSIFIED

Record Images

DF-2047.034

MAR 2002

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

Visiting Application

Metropolitan Correctional Center

150 Park Row

New York, N.Y. 10007

Date:

RE:

Inmate Name and Registration number

Dear:

I am requesting that you be included among my approved visitors. In order to establish your suitability as a visitor, it may be necessary for institution officials to send an inquiry to an appropriate law enforcement or crime information agency to ascertain whether or not placing you on my list would present a management problem for the institution, or have other possible adverse effects. The information obtained will be used to determine your acceptability as a visitor. The Bureau of Prisons’ authority to request background information on proposed visitors is contained in Title 18 U.S.C. 4042.

In order for you to be considered for the privilege with me, it will be necessary for you to fill out the questionnaire and release form below and return it to the following address: Metropolitan Correctional Center

150 Park Row, New York, N.Y. 10007

Attn: Counselor Eklund, Unit 7 South

You are not required to supply the information requested. However, if you do not furnish the information, 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 may be significantly delayed. If the information withheld is found to be essential to the processing of your request, you will be informed, and your request will receive no further consideration unless you supply the missing information. Although no penalties are authorized if you do not supply the information requested, failure to supply such information could result in your not being considered for admittance as a visitor. The criminal penalty for making false statements is a fine of not more than $250,000 or imprisonment for not more than five years or both (See 18 U.S.C. 101).

Forms Returned To The Inmate WILL NOT BE ACCEPTED

Sincerely, (Inmate Signature)

1. Legal Name2. Date of Birth3. Address(Including Zip Code)
4. Telephone Number(Including Area Code)5. Race and Sex of Visitor
6.Are you a U.S.Citizen? YesNo6a.If yes,provide Social Security No:___ 6b.If no,provide Alien Registration No:___ 6c.Provide Passport No:___ 6d.Provide a copy of Drivers License or Passport
7.Relationship to above-named inmate8.Do you desire to visit him/her? YesNo
9.Did you know this person prior to his/her current incarceration? YesNo
10.If the answer to #9 is yes,indicate the length of time you have known this person and where the relationship developed.:

  1. Have you ever been arrested and/or convicted of a crime? If so, state the number, date, place, and nature of the arrest/s and/or conviction/s:

  2. Are you currently on probation, parole, or any other type of supervision? If so, state the name of your supervising probation/parole officer and the address and telephone no. where he/she can be contacted:

  3. Do you correspond or visit with other inmates? If so, indicate the individual(s) and their location(s):

  4. Driver’s License No. and State of Issuance:

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize release to the Warden of: The Metropolitan Correctional Center, N.Y. any record of criminal offenses for which I have been arrested and/or convicted, and any information related to those convictions.

**FORMS RETURNED TO THE INMATE

WILL NOT BE ACCEPTED**

Applicant’s Signature for Authorization to Release Information(Sign and Print Name)

(If applicant is under 18 years of age, signature of parent or guardian indicates consent of minor to visit inmate) If additional space is required, you may use the back of this form. (This form may be replicated via WP) To be filed in Inmate Central File, FOI Section 2

FOI EXEMPT/SENSITIVE BUT UNCLASSIFIED

2020-015777-1 Hcm 3 11000~

26 of 26

UNCLASSIFIED

Page: 37 of 153 - 2020-01577 #1 Record Images (i3).pdf

SDNY_00017867

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