DEPARTMENT OF HOMELAND SECURITY
U.S. Immigration and Customs Enforcement

INCIDENT OF PROHIBITED ACTS AND NOTICE OF CHARGES

Detainee Name: 3 IIMCL -, JEAN A-Numbenw
Na?onatitw I?hsgm. c. Date ?me 0' Went W940

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

Incident Location: Lin.+ Ll 3-09 Work Assignment
Classi?cation Level: 3 Quarters: 
PROHIBITED Acrs~
1.. I Code: 12 
2. Code:
3. Code:
4. Code:
Description of Incident C) Wu I
2 -: 056.0 wean 600d (Ln

 

 

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land Om +91? wr-

 

 

 

 

 

 

 

 

 

 

 

 

Staff Vl?tnesses? Yes No Evidence Attached? Yes No El NIA
8&1:an Memoranda Yes No NIA
00 mm
[Out?me IQILbavdm? ?7 
Name of Reporting Of?cer Date a Time Signature
Reviewed for accuracy prior to investigation by: #79//7 
Supervisor Date a Time
Incident Recorded on Yes No Classi?cation Level Change? Yes CI No
Level change from To

 

ICE Form l-884 (09/09)

DEPARTMENT OF HOMELAND SECURITY
U.S. Immigration and Customs Enforcement

DISCIPLINARY SEGREGATION ORDER

To: SPEC- .I NAGEMENT UNIT Date/Time of 5 ?7

Hum: Me) 
(0 tin Cha'rge ordeslgnee)

Subject: Placemento q, ?bq A-Number Q03 

(Detal Name

 

 

 

 

 

An Institutional Disciplinary Panel Hearing Was Conducted on 8? a? I . The Above
(Date)

Named Detainee Was Found to Have Committed the Speci?ed Prohibited Act(s) listed below.

PROHIBITED 9&m\ All} 

CODE:
CODE:
. CODE:

CODE:
CODE:

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DAYS &0

BELOW IS A BRIEF OUTLINE OF SPECIAL INSTRUCTIONS INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

Admitted: Date: ?37/{7 Time:
I
Released: Date: Time:
Released by.
(Of?oar&Tltla)

ICE Form I-883 (09/09)