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Case 1:20-cv-05614-AKH Document 7-1 Filed 07/20/20 Page 1 of 6

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Case 1:20-cv-05614-AKH Document 7-1 Filed 07/20/20 Page 2 of 6

BP-i\0291 FURLOUGH APPLICATION APPROVAL AND RECORD CDFRM


NOV 12
U.S. DEPARTMENT OF JUST ICE FEDERAL BUREAU OF PRISONS
I nmate 's Name Register No . Institution(address and phone number)
Cohen, Michael 86067-054 FCI OTISVI LLE , POST OFFICE BOX 600,
OTISVILLE, NY 10963
TEL: 84 5-38 6-6700
APPLICATION I
Purpose of Visit : Sentry ~ssignment: Date/Time of Departure Pate/Time of Return
Non Transfer FURLOUGH FURL--~ - -· 05/21/20 10 : 00AM 06/20/20 10 : 00AM
. l. h Add ress l include name of res. sible
r rtl i- lic.ablel :
Cohan, wife
Telephone

Emergency
No.

Point of Contact
CAMP AOM!NrsTATORfi
t:)1v
(Incl~di~g area code) :

'.
Method of Transportation

,//.,.'\. i-f._RIVATE AUTO


De taine r/Pending
Charges
_ _YES ~
Ver~ b~

~ ~ ~ ~ s t eM
taf f)

NOT£ ~O APPLICA.~T,l~ou a~~ ~~minded that should aay unu~ual circumstance$ arise during ch,;, period of you~ vis i t, you should r.otl f y
the institution Lmmediatel.v at telephone : 84S-3S6-6700
UNDERSTANDING I
l understand if c1pproved, I am authorized to be oniy i n t he a,r:ea of destination shown above a nd at the ordinary
stopovers or points on a direct route to or from that destination. I understand that my furlough only extends the
limits of my confinement and that I rema i n i n the cus t ody of the ~ttorney General of t he United State~ . If I fail
to cemain within t he extended limits of t his confinement., ic shall be deemed c1s escape from custody of the
11 orney General . punishable as provided in Section 751 of Title 18, Uni ted States Code. T understand that I rnay
be t horoughly searched upon my return to the institution and that I will be held responsLble foi:- any item or
illicit material that is found . I have re ad , or had read to rne , and \lnderstand that t he foregoing conditions
govern my furlough, and will abido by t:hom. I havo read or had road to me, and r understand the ~ONDITIONS OF
FUR!.OOGH as set fort h on t h e tevei,se of this form.
., ') t •I \
r
J. Del.Jeo a:::·· ( ·- ·~. <.._ Cohen, Michael \ I V
Witne!;.a._ ,;. S.Lgl)a tu rel, o'f. \P.ppl lcanc

CORRECTIONAL COUNSELOR <l .. ; / '-- ".. -;"J,


l. ' -·v
Titla b.:ite St,mod

I ADMINISTRATIVE ACTION I
1nrorrnation veri!ied by : J . Oeteo Title: Coun:ielor
Name of USPO Notifi ed : SONY Mich ael Fitzpatrick CPO Date of Notification :
04-18-2020
Does USPO HQve Any Objections to Furlough? (If so, expla Ln) SONY Takes no position
APPROVAL I
Approval for the above named inmate to leave the A.s CMC , l have reviewed the Request -for A.cti vi ty
]nstitution on a furlough as outlined is hereby Clearance (404) and ,;;he SENTRY CIM Clearance and
granted in accordance with l?.L. 93 - 209 and the BOI? S•P•""' Data aod ! reco-end9 ,• iMate be
FUrlough Program Sta cement. The peri od of Furlough approved to particip~~ ·s urlough .
is
from Q5/2J/202Q JQ ·QQAM ta 06/2Q/?Q2Q JQ ·QQAM ~ ES O NO Signature o C . Walker

'"'7/Ji;;·
~ ef Executive Officer (Name Ir. Date) - Approval and signature certifies CIMS ClearanJe
Approval D Disapproval J. Date :
Reason (s) for disapproval: s/z1/w
RECORD I
D~le/-lme Rel~ased· Dale/Time Ret.ll:r:ned·

Travel schedule: Depart FCI Otisville on 05-21-2020 I I 0:00 A r via private auto - - Colun (son) Will return on
06-20-2020 / I0:00 AM. nless otherwise advised

Furlough status will be reviewed on an ongoing basis and you will be advised if your furlough i extended. Voll are required to return to the
institution at any time, as instructed by institutio n staff.
Case 1:20-cv-05614-AKH Document 7-1 Filed 07/20/20 Page 3 of 6

oP- l\0385 AUTHORIZED UNESCORTED COMMITMENTS AND TRANSFERS COFRM


AE'R LO
O.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRJ:SONS

UNITED STATES DEPARTMENT OF JUSTICE


FEDERAL BUREAU OF PRISONS
AUTHORIZED UNESCORTED COMMITMENTS AND TRANSFERS
THE eRISONER IOENTiftED BELOW AAS BEEN AUTHORIZED ~OR
U ESCORTED CO MMIT MENT TO YOUR FACILITY.

AUTHORIZ~D BY : Signatuce and Title DATE DOJ MNEMONIC

J . PETRUCCI, WARDEN ~
NAME OF PRISONER REGISTER/DOCKET NO. REl?ORT DATE: RE?ORT TO (DOJ MNEMONIC):
COHEN , MIC HAEL 86067-054
a,v - - -
OfSCHARCE AUTHOR1TY RECE!V ! M AUTHORJTY

FI~GERPRIN 7 - Rf 'HT THUMB - FULL ROLL EI NCERPRINT - R[GHT THUMB - rULL ~OLL

COMPA~~o ANO VERlrJED ~y


P~I NTEO NAME. SIGNATURE or STAFr

PHCTOGllAl? H DAT£ tlATt

PDP ~r~sc~lb d by ?51~0 REPLACES B?-385. 051 DTD J~L / ·J


Case 1:20-cv-05614-AKH Document 7-1 Filed 07/20/20 Page 4 of 6

Inmate ' s l?hoto


Conditions of Furlough

(al ill\ inmate who violates the conditions of a furlough may be considered an escapee under 18 O. S.C . § 4082
or 18 u.s.c . § 751, and may be subject to ciiminal prosecution and institution disciplinary action.

(b l A furlough will only be approved if an inmate &gree~ to the .(allowing condicions dnd. understand tha ,
while on futloUQh, he/she:

(l l RemaLns in t he legal custody of the u. s . Attorney General , in service of a term or


imprisonment;
(2) Is subject to prosecution for escape if he/she tails to return to the institution at the
design ated time ;
(J) rs subject to institution disciplinacy action , arrest, and criminal pro~ecution for violacing
and condition(s) of the furlough ;
(4) May be thoroughly searched and given a urinalysis, breathalyzer, and other comparable test ,
dur i ng the fllrlough or upon return to the insti t ution , and must p ee-aut h orize t he cost or such
test(s) if t he inmate or family members are paying the other costs of the furlough. The inmate
must pre-authorize all testing fee(s) to be withdra wn directly from his/her inmate deposit fund
account ;
(5) Must. cont/J.Ct t:he institution (<>r onit:ed states Probation Officer) in the eve1 t of a.r est, or
any other serious difficulty or illness ; an.ct
(6) Must comply with any other special instructions given by t;he institution.

Special I nstructions: INMATE HAS BEEN ADVISED AND UNDERSTANDS THAT HE MU'ST CALL
I NTO THE INSTITUT I ON EVERY WEDNESDAY BETWEEN 12:00PM .AND 3 : 00PM TO CHECK IN. 845-386-
6854 OR THE INSTITUTIONS MAIN NUMBER 845-386-6700 , ASKING FOR CAMP UNIT TEAM IF NO
RESPONSE IS RECEIVED ON THE PREVIOUS NUMBER. LEAVING A VOICEW\IL IS NOT ACCEPTABLE. HE
FURTHER UNDERSTANDS THAT IF HE FAILS TO MAKE CONTACT WITH THE INSTITUTION, ON THE
SPECIFIED DAY AND TIME, HE WILL BE PLACED ON ESCAPE STATUS.
It has been determined that consumption of poppy seeds may cause a positive drug test which may
result in disciplinary action. As a condi ti.on of my pa.rticipation in community programs , r will
not consume any poppy seeds or items containing poppy seeds.
(Note, Additional co11ditions m<1y be added to Speci.al lnstcuct:ion~ as war ranted) .
(c ) While on furlough, the inmate 111ust not :
(1) Violate the laws of any jurisdiction (federal , state, or locall;
12) Leave t:he area oc his/her turl.ough without permission, except for tiaveling to the furlough
destination, and returning to the institution ;
(3) Purchase, sell, possess, use, consume, or a dminister any narcotic drugs, marijuana , alcohol, or
intoxicants in any form, or ~cequen t: any pla ce where such articles are unlawfully sold,
di3pensed , u:,ed, or given away ;
( 4) Us e medic;,tion that is not prescribed and given to the inmate by t he insti t ution me dical
department or a licensed physician ;
(:;) Hav e any rned ical/dental/surgical/psychiaLric treatment: wichout the s t aff ' s written per11U.ssion,
unless t here is an emergency. Upon r.eturn to the institution, the inmate must notify
institution staff i f he/she received any prescribed medication or treatment in the commu nity
fo r an emergency;
(6) Possess and fir~arm or othor dangcrou~ we ~pon ;
{7) Get married , s ig n a ny l e gal papers , contracts , loan applications, or conduct any business
wit hout staff 1 s written p ermission ;
(6) Associate wich persons ha~ing a crlndnal record or with persons who the inmate knows to be
enga ged in illegal activities without staff ' s written permission;
(9) Drive a motor ve h icle without staff ' s written permission, which can only be obtained if the
inmate has pr oof of a curre ntly valid driver ' s license and proof of appropriate insurance ; or
(10) Retur n f r om furloug h wit h a ny thi ng the i n111ato did not take out with him/her ( for example,
clothing, jewelry, or books)

r have read, or had read to me , a nct I understa abov e conditions concerning my fu r lough and agree to abide by
them.

- ~
8 6~0_6_7_-_o~5~4_ _ _ _ __ ~ Da te :

Signature/printed Name of Staff Witness :~~J~,.....P~e-Le&o><.l. /c~o..... ~ ~ ~ ~ ~ ~a~ ~ ~ ~ ~ ~ ~ ~ ~~~~~~~~~~~~~~~~~~~~~


Case 1:20-cv-05614-AKH Document 7-1 Filed 07/20/20 Page 5 of 6

BP-A0291 FURLOUGH APPLICATION -APPROVAL AND RECORD cDFRM


JAN II
U.S. DEPARTMENT OF JUSTIC~ FEDERAL BUREAU OF PH.ISO

Inmate's Name· Register No.: Institution (address and phone number):


FCI on VILLE
COHEN, MICHAEL 86067-054 POST OFFICE BOX 600
on VILLE. Y 10963
TEL: 845-386-6700
APPLLCATIO
Purpose of Visit Sentry Assignment Date/Time of Depam,re Dotc!Timc of R<>tum
TRA SFER FURL TRAN
FURLOUGH
Furlough Address (indudc name of responsible pan if applicable):

Telephone No.

Poi m ofConmct for Em~r3ency. Method of Transportation: Detainer/Pending 01argcs: Verified by (CSM Stall)·

SAME AS ABOVE PRIVATE NONE r Yes rNo

NOTE TO APPUC, NT: You ore reminded thnt ~hould any unusu~I circums1anccs arise during 1hc period of your visit, yo11 shou ld notif, the institution immediatel y at telephone;
845-386-6700

UNDERSTANDING

l understand that if approved. I am authoriied to he only in th e area oflhe destination shown above and at ordinary stopovers or poinis on n di rect
route to or from tl1at destination. I understand that my furlough only extends the limits ofmy confinement and that l remain in the custody of the
Attorney General of the United States. If I fai l to remain within the extended limits or this confinemen t. it shall be deemed as escape from the custody
of the Attorney General. punishable as provided in Section 75 1 of Title 18, United Slatc-3 Code. I understand thal I muy b thoroughly searcl1ed upon
my return lo tl1e inslilution and that I will be held responsible for any item of con1rabm1d or illicit material 1hal is found. I have read or had foacl to
me, and I understand Lhat the fore · g co11ditions govern my furlough. and will abide by them. I have 1~ead or had read to me, and I understand th~
CONDITIONS or FURLO~ sci forth on the reverse fthis form .
V. TAFFURI 1. )i {j I
COHEN, MICHAEL
---------------,--------------------1
Applicant Signawrc of

Title Dille Signed Dale Signed

ADM INISTRATIVE ACTION

lnfonnalion Verified b .GULLrYER Tille: CA EM NAGER


Nnme Of usro Nouficd: Michael Fil1.patrick, Chief Date or Notiticallon:

Docs USPO Have Any ObJCCtions 10 F11rl011gM

APPROVAL

Approval for the above nnmed Inmate to leave the Institution on a furlough tl.S outlined is As CMC, I have revi•wed the Request for Activity Clearance (404) ~nd the ~ENl"R Y CIM
hereb granted in accordance ,vith P.L. 93-209 and the BOP Furlough Program ~-1 ranrc and Sepnrntcc Data a I recon end the-inmate be approved to panicipnte in thrs
StatemenL The period of furlough is fu ough
from cs rNo
to ~
c-==========-------------I
r=s.::lg'.::na:::t:::ur~e~o:_rc:_·M~.

Chicj:,£xecuuve omccr (Nnme & Dnlf) - Approval and signature ccnifies


r ,l'(pproval
'S/z.1 /Z;t:>
.,1.-f,f'"N'ftll,I.....
r Disa roval J. PETRUCCl WARDEN Date:
llca!itln M for disaoprmm.J.:

RECORD

Travel Schedule: DEPART: ON _ _ _ _ _ _ _ VIA PRIVATE


TRANSPORTATIO
REPORT TO:
TELEPHONE:
YOU ARE TO ARRJVE O LATER THA
RenlnrP< RP-AO?OI r APP 1n
Case 1:20-cv-05614-AKH Document 7-1 Filed 07/20/20 Page 6 of 6

J'U -
- ----- •

Inmate's Photo

Conditions of Furlough
(a) An inmote who violales the condit ions or a furlough may be considered an escnpec under l 8
.S.C. § 4082 or 18 U.S.C. § 75 1.and may be . ubjccl to criminal prosecution and institution di ciplinnry action .
(bl A fur lough will only be approved ifan inmate agrees to the following conditions and understands
that, wh ile on furlough, hetsl1c:

( I) Remains in the legal custody of th • U.S. Attorney General. in service ofa term of lmpri. onment;
(2) Is subject lo prosecution for escape if he/she foils to return to the institution at lhc designated time;
(3) !:; subjecL 10 inslitulion disciplinary action, anest, and criminal prosecution ror violating any condition s) of the furlough;
(4) May be thoroughly earched and given a urinalysis, breathulyzcr, and ol11cr comparable test. during lhe fur lough or upon return
to the in tiiution. and must pre-authorize the cost of such test(s) if the inmate or family members are paying the other costs or th e
furlough . The inmate must pre- authorize all testing fec(s) to be withdrawn directly from hisfhcr inmate deposi t fund account;
(5) Must contacLthe in~titution (or itcd lntllS Probation Officer) in the event of arrest, or any other serious difficu lty or il lness·

And
(6) Must comply with :u,y other special ins1ruc1ions given by the inslitution.
Special Instructions:
ll has been determined that the consumption of poppy seeds may cause a positive drug test which may result in disciplinary
action. As a.condition ofmy participntion in community programs, I will not consume any poppy seed. or item containing
poppy seeds
(Note: Addilionnl conditions may be added to pec ial Instructions as \\larrantcd).

(c) Whi le on furlough , lhc inmate must not:


(l) Violate the laws of any jurisdiction (ledcral, state, or local):
(2) L ave the area of his/h r furlough without I t!rmission. exccpl for traveling to lhc forlougb
destination, and returni ng to th e institution;
(3) Purchase, sell possess. use, consume, or administer any narcotic drugs, marijuana, alcohol, or
intoxicants in any form, or frequent any place whore such art icles are unlawfully so ld,
dispensed, used, or given away:
{4) Use mcdicalion that is 1101 prescribed and given to the inmate b the institu tion medical
department or a licensed physician;
(5) I-lave any medical/dental/surgical/psychiatric treatment wi thout staff's \\Tilten permission, unless
there is an emergency. Upon return to the institution, the inmate must notify institution staIT if
he/she received any prescribed medication or trea1mcnt in the community for an emergency·
(6) Possess any firearm or other dangerous weapon;
(7) Gel married, sign any legal papers, c ntraets, loan appliClltions, or conduct any business
without staff's written pennission ;
(S) Asso~iate with persons having a criminal record or with persons who the inmate knows LO be engaged
i11 illegal activities withou Lstaff' s writ1e11 permission;
(9) Drive a motor vehicle without stDrl s written permission. which cau only be obtained if the inmate
hll.S proofofa currently valid driver license and proof of appropria te insurance: or
( IO Return from fur lough with m1yth ino the inmate did 11 01 Lake out with him/her(for e ·tmlple,
clolhing, jeweliy, or books.

I have read. or had rend to me, and I understand the abo ,e ·-0ndi1ion concerning my furlough and agree to abide by them.
Inmate's, ignalure: , ~ Reg. No.: 86067 -054 Date: _ _ _ _ _ __

Signa1ure/Printcd ame ors1afTWilness: _v_____. ""'T""A."'F""F""•U.c. R c.=l-,-t---"--'--fff-- ---------------------------

R.ccord Copy- Inmate Central Pile; Copy- Com rol Cemcr, ~cf Correc1io11al erviccs Supervisor,
Correct ional SYStemi Oepartmenl lnmale Use on Purlot,gh

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