EFTA00120669.pdf

BP-5377.058 PRISONER REMAND CDFRM FEB 04 V.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS ARRESTING OFFICER WILL COMPLETE,ALL REQUIRED Register Number DATA ON THIS FORM PRIOR TO COMMITTING TO MCC/MDCs. Name: Middle U R AKAs: Race (C,heck) Sex/ (Check) Ethnic Origin (Check) D.O.B. SSN: r'/if: INS: B /W - A I /em __F Hispanic or/Other Other: CHARGES CHECK-CATEGORY OF CHARGES(S): .FELONY . MISDEMEANOR • CIVIL CONTEMPT • - MATERIAL WITNESS...... OTHER NARRATIVE: M i.' Se VU-Li t t- .-ccitAp Title: USC: NARRATIVE: Title: USC: Date of Offense: Date of Arrest:.- Place of_ Arrest . State of Birth Country.ot Birth Citizenship Current Addrese Zip Code.:. Height Weight . Hair' . Eyes. Scars'L.Marks / Tattoos Ft: In: Injuries /Medication Emergency, Contect:(Namer Address, Phone Number) Arraigned Sentenced Special. Handling: _Y or iN Remarks: Remanding Official (Name) Agency/District Phone/24 Hour Number Sign Print Agency/District Phone/24 Hour Number Print & o f *Receiving Official (Name): Date / -Time Relear Official- (Name) Date /. Time' sign Print Sign ( ... . ;)..— I 1 CI I I C\ re Print.S..,44--..-. Sentry Load Data: (Must Initial) - (OPTIONA Name Search Completed by: - ARS Code Staff Init. Add AKA' Llearance/Separate Checked- by: Create Cash- Account - Deposit Cash. Amt. Detainers Court Clothing Bag I Original-for ISM.aS Remanding-Removal receipt; Copy-for. Control. a%Removal.Receipt 4NCICW0opy-For Removing,Officiel; Copy-for Contr61 as Remanding Receipt (Inmate); Copy-INS-Alien in Custody.-- • 4Thistform may be replicated via- WM. This form replaces BP-5377(58). and BP-377(5B):of JUL. 91 EFTA00120669 EFTA00120670 EFTA00120671 EFTA00120672