UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI CRIMINAL CASE COVER SHEET Place of Offense St. Joseph Southern Division of Filing Western Central Southwestern Matter to be Sealed Secret Indictment Juvenile Jackson County and elsewhere Defendant Information Defendant Name Alias Name Birthdate Related Case Information Superseding Indictment/Information Yes Yes New Defendant Prior Complaint Case Number, if any Prior Target Letter Case Number, if any ____________ U.S. Attorney Information AUSA Interpreter Needed Yes Language and/or dialect No Location Status Arrest Date Currently in Federal Custody Currently in State Custody No if yes, original case number No Writ Required Warrant Required Yes Yes No No Currently on Bond U.S.C. Citations Total # of Counts Index Key/Code/Offense Set Level 1 2 3 4 5 Description of Offense Charged Count(s) (May be continued on reverse) Date Signature of AUSA American LegalNet, Inc. www.FormsWorkFlow.com