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Page 1057 a ? . a r BPs o2es ‘ ' INCIDENT REPORT ANAT U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS art | — Incident Report : institution: MCC New York ncident Report Number: nmate’s Name: 3. Register Number: ate of Incident: Epstein , Jeffery 76318-054 07/23/2019 5. Place of Incide 7. Assignment: SHU M-Tier Cell 124 Unassigned 3. Incident: seit Mutilation 0. 41. Description of incident (Date: 97/23/2019 Time: 1:27AM Staff became aware of incident): b}(6); (DFC) p. DO tng mployee: . Wate And lime: a. Incident Rep : Rain Inmantode 5. é 3 : 6. Time incident Report Delivered: (Type Name/Slanat re):|" a [Ll ¥o, B, _ The Committee is referring the Charge(s) to the DHO for further He Cc. The Committee advised the inmate of its finding and of the right to file an appeal within 20 calendar days. 18. A. Itis the finding of the committee that you: Committed the Prohibited Act as charged: Did not Commit a Prohibited Act. Committed Prohibited Act Code (s). 19. Committee Decision is Based on Specific Evidence as Follows: AOC rN i gf I es | TZ a SRE ART _ OO ALL A A OY. Sr Zz CTY Ren ofr ey Se 742 *= q yo ember (Typed Name): lems ou of heavy rule are for use only. Begin entries with the number T and work up. es not completed will be voided by staff. Distribute: Original-Central File Record; COPY-1-DHO: COPY-2-Inmate after UDC Action; COPY 3-Inmate within 24 hours of Part | Preparation PDF Prescribed by P5270 Replaces BP-A0288 of AUG 11 DOJ-OGR-00025280