✎AO110 (Rev. 04/07) Subpoena to Testify Before Grand Jury UNITED STATES DISTRICT COURT Northern Ohio DISTRICT OF TO: Cuyahoga County Medical Examiner’s Office Attn: Custodian of Records 11001 Cedar Avenue Cleveland, OH 44106 SUBPOENA TO TESTIFY BEFORE GRAND JURY SUBPOENA FOR: ✔ DOCUMENT(S) OR OBJECT(S) G PERSON G YOU ARE HEREBY COMMANDED to appear and testify before the Grand Jury of the United States District Court at the place, date, and time specified below. PLACE COURTROOM Carl B. Stokes U.S. Courthouse 801 W. Superior Avenue Cleveland, Ohio 44113 Grand Jury Suite, Lower Level 1 DATE AND TIME 4/23/19 @ 9:00am YOU ARE ALSO COMMANDED to bring with you the following document(s) or object(s):* Please See Attachment. YOU MAY SEND THE REQUESTED RECORDS, PREFERABLY IN ELECTRONIC FORMAT ON CD, VIA EXPRESS MAIL, OR OVERNIGHT DELIVERY SERVICE DIRECTLY TO SPECIAL AGENT RAO, FBI 1501 LAKESIDE AVE. CLEVELAND, OH 44114 OR IN ELECTRONIC FORMAT VIA E-MAIL TO PCRAO@FBI.GOV, AND THEREBY AUTHORIZE THE SPECIAL AGENT TO PRESENT THE DOCUMENTS TO THE GRAND JURY ON YOUR BEHALF. G Please see additional information on reverse. This subpoena shall remain in effect until you are granted leave to depart by the court or by an officer acting on behalf of the court. CLERK DATE SANDY OPACICH, CLERK 3/22/2018 (By) Deputy Clerk /s/ Robert T. Pitts NAME, ADDRESS AND PHONE NUMBER OF ASSISTANT U.S. ATTORNEY This subpoena is issued on application of the United States of America * If not applicable, enter “none”. USAO# 2018R01152 Justin Seabury Gould, Assistant U.S. Attorney 400 United States Courthouse, 801 West Superior Avenue Cleveland, Ohio 44113 Telephone: 216-622-3869 Special Agent Preetham Rao Telephone: 216-622-2866 AO110 (Rev. 04/07) Subpoena to Testify Before Grand Jury RETURN OF SERVICE (1) DATE PLACE DATE PLACE RECEIVED BY SERVER SERVED SERVED ON (PRINT NAME) SERVED BY (PRINT NAME) TITLE STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL 0.00 DECLARATION OF SERVER (2) I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Proof of Service is true and correct. Executed on DATE SIGNATURE OF SERVER ADDRESS OF SERVER ADDITIONAL INFORMATION (1) (2) As to who may serve a subpoena and the manner of its service see Rule 17(d), Federal Rules of Criminal Procedure, or Rule 45(b), Federal Rules of Civil Procedure. “Fees and mileage need not be tendered to the witness upon service of a subpoena issued on behalf of the United States or an officer or agency thereof (Rule 45(b), Federal Rules of Civil Procedure; Rule 17(d), Federal Rules of Criminal Procedure) or on behalf of certain indigent parties and criminal defendants who are unable to pay such costs (28 USC 1825, Rule 17(b) Federal Rules of Criminal Procedure)”. Please read instructions below and provide records in non-proprietary electronic format when possible. FOR QUESTIONS please contact Special Agent Preetham Rao, 216-622-2866, PCRAO@fbi.gov or Special Agent Lisa Kaplan, 216-622-6869, LLKAPLAN@fbi.gov ATTACHMENT TO SUBPOENA ISSUED TO: Cuyahoga County Medical Examiner’s Office Attn: General Counsel or Custodian of Records 11001 Cedar Avenue Cleveland, OH 44106 METHOD OF RETURN: Fed-Ex: Federal Bureau of Investigation 1501 Lakeside Avenue Cleveland, Ohio 44114 Squad CV-8 Attention Special Agent Rao or Special Agent Lisa Kaplan OR E-Mail PCRAO@fbi.gov LLKAPLAN@fbi.gov REQUEST FOR RECORDS Cuyahoga County Medical Examiner’s Office is requested to provide any and all Medical Examiner’s Verdicts and toxicology reports for autopsy or other post mortem examination performed on body of: Name: Brenden Kiekisz Date of Birth: 11/18/1991 Records include but are not limited to any documentation or history provided to the Cuyahoga County Medical Examiner’s Office to assist in rendering a verdict: • • • • • • • • Statements or notes of transport personnel Statements or notes of pronouncing physician Statements or notes documenting resuscitation efforts Physician or nurses’ notes Symptoms of which patient complained Deathbed statements Administrative reviews from Cuyahoga County Jail Clinical mortality reviews from Cuyahoga County Jail RECORD FORMAT Records are preferentially requested in the form of magnetic/digital media. Data may be provided by e-mail, on DVDs, CDs, or secure portal. Records are requested within 30 days of receipt of this letter. A rolling production is acceptable as coordinated with requestor. 1 Please read instructions below and provide records in non-proprietary electronic format when possible. FOR QUESTIONS please contact Special Agent Preetham Rao, 216-622-2866, PCRAO@fbi.gov or Special Agent Lisa Kaplan, 216-622-6869, LLKAPLAN@fbi.gov Please do not hesitate to contact the investigating Agents regarding questions or concerns with respect to record volume, scope, or relevance. 2 CERTIFICATE OF AUTHENTICITY OF BUSINESS RECORDS I, , declare, pursuant to Title 28, U.S.C. § 1746, (Name) that I am employed by and that (Name of Business) my official title or position is . I further (Official Title or Position) declare that I am a custodian of records of said business and that each of the records attached hereto is the original or a duplicate (exact photocopy) of an original record in the custody of . (Name of Business) I further state that: A) such records were made, at or near the time of the occurrence of the matters set forth, by (or from information transmitted by) a person with knowledge of those matters; B) such records were kept in the course of a regularly conducted business activity; C) the business activity made such records as a regular practice; and D) if such record is not the original, such record is a duplicate of the original. I declare under penalty of perjury that the foregoing is true and correct. (Signature) (Date of Execution) __________________________________ (Place of Execution)