EFTA00109581¶
646-836-6300 EXT 6390¶
CDFRM¶
U.S. DEPARTMENT OF JUSTICE¶
ARRESTING OFFICER WILL CONFERENCE ALL REQUIRED DAYS ON THIS FORM PRIOR TO COMMITTING TO ACCOUNT:¶
| Name: Last | First | Middle |
|---|---|---|
| AXA:s: |
Race (Check) B W A I M F Sex (Check) Ethnic Origin (Check) Hispanic or Other D.O.B. SSN: FBI: INS Other:¶
CHARGES CHECK CATEGORY OF CHARGES(S): PELONY MISSEMGEANOR CIVIL CONTEMPT MATERIAL WITNESS OTHER NARRATIVE: USC: NARRATIVE: USC: Title: USC:¶
Date of Offense: Date of Arrest: Place of Arrest:¶
State of Birth Country of Birth Citizenship Current Address Zip Code¶
Height Ft: Weight Hair Eyes Scars / Marks / Tattoos¶
Injuries / Medication Emergency Contact:(Name, Address, Phone Number)¶
Arraigned Y N Sequenced Y N Special Handling: Y or N¶
IN IN IN IN¶
Remanding Official (Name) Sign Agency/District Phone/24 Hour Number¶
Print¶
OUT OUT OUT¶
Removing Official (Name) Sign Agency/District Phone/24 Hour Number¶
Print¶
FOR BOP USE ONLY¶
Receiving Official (Name) Date / Time Receiving Official (Name) Date / Time Print Print Print¶
Sentry Load Data (Just Initial) (OPTIONAL USE) Staff Init. Name Search Completed by: Clearance/Separate Checked by: Clothing Bag RIGHT THUMBPRINT¶
Sentry Load Data (Just Initial) (OPTIONAL USE) Staff Init. Name Search Completed by: Clearance/Separate Checked by: Clothing Bag RIGHT THUMBPRINT¶
Original-for ISM as Remanding-Removal receipt: Copy-for Control as Removal Receipt (NCIC); Copy-For Removal Official; Copy-for Control as Remanding Receipt (NCATE); Copy-NC-Alien in Custody.¶
(This form may be replicated via WP) BP-377(58) and¶