LA1% LNMRCENIE\ I MASI FIVE I N. l)rpartment of Justice oiled States .%larshals Sin ice Personal History of Defendant liken i to Federal custody by the following: Street Arrest (not from a correctional detention facility ) O Custodial Arn:si (from a correctional detention facility) K estrrit 1 sed (Must pros ide copy of yyrit) /4141:'-'r Prior Federal Arrest or Safi:keeper - Register u: O lyarckecper Location: Blind( \PIM \I INISIlt \ I \ I lit\ Last Name: 7- Sex: r Transgendcr flair: 6 City of Birth: et 1:10 N: Resident Address/City/State/ZIP: 9 ex* home Phone: Cell Phone: 1 First Name: Eyes: S/oct Statett'ountry of Birth: State Inn: rivy9 Middle Name: lull RI ( v.! Agent Last Name Agent Phone N: I.ocation/Facility of Arrest: Court Docket 0: Al SA(s) Assigned: gencv 0121: 01 I I NNI I NCR' Code Charge Description SitlArr/C.,11,/j t.st. 7/ Known Detainers/%Varranis: eft' O •i• - Agency: ( \I 'Inv. \\I) \ii 1)11 tAiusi pan lilt a rap) of am ;Mann n) Lung Term Medical Conditions bean problem.. Jabot.. mama. Where uloth. I II V. AIDS. Seim ItIK. met O Psychiatric/Emotionally Disturbed ir.s.. mental health f011talli...ultid Al. etc.1: Injuries/Medical Ailments/Post-Op Recovery: D Do the shove conditions empire: Medical attention? N O 1' Medication? \ K 1' Medical clearance by a licensed physician: Nit] \ K 1' Is Defendant under the influence of drugs or alcohol: ism K 1' Languages - F:nglivh: K N .16❑ i.imited Other Language: N • i.ist: Security Cautions: C rrent or former military t or former public official I gild,: liw diplomatic immunity Ihreal to witness (Describe Moo/ 0 Current or former I.I. corrections K Assault on LI: corrections K Leadership mk O Ci /Describe below, El Current or runner intelligence K SAM subjr:ct or candidate K Separation weds ilktecrine Mott I K Other !Describe helm.; Title/Code TES Page I or 3 Form USM-312 Rev 11/17 EFTA00040006