EFTA00152421

# UNITED STATES DEPARTMENT OF JUSTICE

UNITED STATES MARSHALS SERVICE
SOUTHERN DISTRICT OF NEW YORK

ARRESTEE INFORMATION

Before any arrestee can be processed by the USMS any and all medical problems/conditions must be declared.

This form must be completed for each arrestee and given to the responding USMS personnel before the arrestee will be received for processing.

Does arrest e have a prior federal arrest? Circle: YES NO If yes, please list the arrestee's USMS number. If you cannot identify USMS number, please provide arrest information (IE: date, arresting agency, location)

Arrestee's representation for this days proceeding: (Circle) Legal Aid CJA retained MARTY WRIN

If legal aid, has arrestee met with counsel? Circle: YES NO

Does the arrestee have any current detainers? Circle: YES NO

If yes, please list:

Doe arrestee have any long term medical condition or conditions (to include: heart problems diabetes, asthmatic tuberculosis, HIV, AIDS, hepatitis etc.)? Circle: YES NO

Does arrestee require medication/medical attention for this condition? Circle: YES NO

Do you, as the arresting agent, currently possess at least one day dosage of the arrestee's medication?

Circle: YES NO

Explain:

Does arrestee have/display/complain of any other medical ailments(IE: broken bones, open wounds etc.)?

Circle: YES NO

Does arrestee require medication/medical attention for this condition? Circle: YES NO

Do you, as the arresting agent, currently possess at least one days dosage of the arrestee's medication?

Circle: YES NO

Explain:___

Is the arrestee a drug addict/user? Circle: YES NO If yes, does this require any special medical program (IE: methadone treatment)? Explain:___

Do you, as the arresting agent, if applicable, possess a medical clearance/fit for confinement letter from a healthcare professional? Circle: YES NO (Please attach) ARRESTEE PROCESSING CHECKLIST

ARRESTEE PROCESSING CHECKLIST

Please check when completed

1. Have you completed any and all USMS paperwork.

   To include: USMS 312 (Please fill out all forms as completely as possible)

2. Attached a photo of arrestee to paperwork.

3. Fingerprint cards

   *1 for USMS file

   *1 for the FBI for FPC classification

4. Filled out and attached the BOP-9.

5. Strip searched arrestee.

6. Taken any and all pre

ARRESTING AGENT:

AGENCY: NYPBJ-30C-20

CONTACT # WHILE IN THIS BUILDING:

*****NOTE TO ALL ARRESTING AGENTS*****

Be advised, the USMS provides the COURTESY of holding and producing arrestee prior to the arrestee's magistrate court appearance. However, the arrestee is not considered a USMS prisoner until a U.S. Magistrate Judge REMANDS said arrestee to USMS custody. This means that as the arresting agent, you must be available at all times to respond to any and all matters concerning your arrestee, as you are the responsible party.

United States Marshals Service Policy and Procedures Manual 5.1-1.(a)

EFTA00152422

LAW ENFORCEMENT SENSITIVE

Remarks:

<table border="1"><tr><td colspan="7">ALIASES</td></tr><tr><td></td><td>ALIAS Last Name</td><td>ALIAS First, MI</td><td>Remark</td><td>Date of Birth</td><td>SSN</td><td>State Driver&#x27;s License</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>

ASSOCIATES / CO-DEFENDANTS / RELIVIVES / CHILDREN / SIGNIFICANT OTHER

<table border="1"><tr><td>Relationship</td><td>Last Name</td><td>First, MI</td><td>Register #</td><td>Resident Address, City, State, ZIP Code</td><td>Phone</td></tr><tr><td></td><td></td><td></td><td>-</td><td></td><td></td></tr></table>

## MARKS

<table border="1"><tr><td>Scar/Mark/Tattoo(Specify)</td><td>Location</td><td>Description</td></tr><tr><td>N/A</td><td></td><td></td></tr></table>

<table border="1"><tr><td>Vehicle Year</td><td>Make</td><td>Model</td><td>Color(s)</td><td>Vehicle Style</td><td>State and Plate #</td><td>Registration Date</td><td>VIN</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>

## LICENSES

<table border="1"><tr><td>License Number</td><td>License State</td></tr></table>

## MISCELLANEOUS NUMBERS

<table border="1"><tr><td>Miscellaneous Number</td><td>Type(Select from dropdown menu or type below)</td><td>Remarks(e.g., Issuing State or Country, etc.)</td></tr><tr><td></td><td></td><td></td></tr></table>

## OCCUPATIONS

<table border="1"><tr><td colspan="2">Occupation: Self Employed</td><td colspan="2">Company/Employer Name: Southern Trust Comp.</td></tr><tr><td colspan="3">Employment Address: VIREDEN ISLANDS</td><td>Phone: 340-775-2525</td></tr><tr><td>Start Date:</td><td colspan="2">End Date:</td><td>Point of Contact:</td></tr></table>

## FINANCIAL

<table border="1"><tr><td>Bank Name</td><td>Account Type</td><td>Account #</td><td>Branch Address</td><td>Phone #</td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr></table>

## MILITARY

<table border="1"><tr><td>Branch</td><td>Rank</td><td>Entry Date</td><td>Discharge Date</td><td>Discharge Type</td><td>Military Occupation</td><td>Remarks</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>

## REMARKS

Additional Information/Remarks/Continuation:

<table border="1"><tr><td colspan="2">Defendant Risks: *Requires remarks below</td><td colspan="2">Sex Offender:</td></tr><tr><td>Escapee</td><td>Planned Murder</td><td>Arrest</td><td>Conviction</td></tr><tr><td>Organized Crime*</td><td>Protected Witness</td><td>Registered</td><td>Registration Violation</td></tr><tr><td>International Terrorist</td><td>Domestic Terrorist</td><td></td><td></td></tr><tr><td>Gang Member*</td><td>Significant Criminal History</td><td></td><td></td></tr><tr><td>Multiple Defendants</td><td>Death Penalty Case</td><td></td><td></td></tr></table>

U/LES

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| Form USM-312 | Rev 11/17 |
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