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SUBJECT: ARRESTING AGENTS: - oe Soe PLACE OF ARREST: DATE OF ARREST: TIME OF ARREST: TIME ADVISED OF ADVISING AGENT: TIME SUBJECT SIGNED WAIVER OF RIGHTS: ey TIME SUBJECT TRANSPORTED TO FBI OFFICE:__ w/a Ay ty: - BEGINNING MILEAGE: : ENDING fritiace:, TIME TIME TIME PEDIGREE “TAKEN: I. yr) TIME INTERVIEW BEGAN: fh TIME SIGNED STATEMENT TAKEN: V/A TIME INTERVIEW CONCLUDED: wf, A TIME SUBJECT TRANSPORTED FOR HEARING/ NCE RARTONS PLACE oF LE con: SUBJECT TURNED OVER TO CUSTODY OF: in fan noel TIME oo ae yen AT COURT/JAIL: 4S on-__ Marshal's rebssegh SUBJECT APPEARED BEFORE US MAGISTRATE: RESULT OF HEARING: RECORD OF REQUESTS: B:34em- asiad or nurse Stwled wnen get teed | MAL, nawe eel 2ures Dt MMS not happoéene vel | 2:36am called Nurse ; otercd tod, whe, anti nos SPECIAL AGENT, FBI FBI(19-cy-1495)-2115, an a Log 77Me