EFTA00109582

# U.S. DEPARTMENT OF JUSTICE

## FEDERAL BUREAU OF PRISONS

### ARRANGING STUDENT WILL CONTAIN ALL RESPONDING INFORMATION THIS FORM PRIOR TO COMMITTING SO MOVING USCs.

**Name:** Last
**Name:** First
**AKAs:**

**Race (Check)**
*L_B_W_A_I*

**Sex (Check)**
*M_F*

**Ethnic Origin (Check)**
*Hispanic or Other*

**D.O.B.**
SSN:

**FEI:**
INS:
Other:

### CHARGES CHECK CATEGORY OF CHARGES(S):
**PELONY**

**MISSDEMANOR**

**CIVIL CONTEMPLATION**

**MATERIAL WITNESS**

### OTHER

**MARRATIVE:**
**Title:**
**USC:**
**NARRATIVE/VTE:**
**Title:**
**USC:**

Date of Offense:
Date of Arrest:
Place of Arrest:

### State of Birth
**Country of Birth**
**Citizenship**

### Current Address

### Height
Ft: In:
Weight
Hair
Eyes

### Scars / Marks / Tattoos

### Injuries / Medication

### Emergency Contact: (Name, Address, Phone Number)

### Arraigned
*Y_N*

**Sentenced**
*Y_N*

**Special Handling:** *Y_or_N*

### Remanding Official (Name)
Sign
Print

### Agency/District
USC

Phone/24 Hour Number

### OUT
OUT
OUT

### Removing Official (Name)
Sign
Print

### Agency/District
Phone/24 Hour Number

## FOR BOP USE ONLY

### Receiving Official (Name)
Sign
Print

### Date / Time
Receiving Official (Name)
Date / Time
Print

### Sentry/Load Data (Must Initial)
Name/Search Completed by:

### Clearance/Separate-Checked by:

### OPTIONAL DUE)
**ARE Code**
Add AKA's
Deposit Account
Deposit Cash
Detainers
Clothing Bag #

### Staff Init.

### RIGHT THUMPRINT

### Original for ISM as Remanding-Removal receipt; Copy-for Control as Removal Receipt (NCIC); Copy-For Removing Official; Copy-for Control as Remanding Receipt (Immateria); Copy-INS-Allen in Custody.

(This form may be replicated via WP)

EFTA00109583

# U.S. DEPARTMENT OF JUSTICE

**ARRESTING OFFICER WILL COMPLETE ALL REQUIRED DURING BURNS PRIOR TO COMMITTING TO POCU/ADA:**

| Name: Last | First | Middle |
| :--- | :--- | :--- |
| AKAa: | | |

**RACE (Check)**
- **B** _W_ _A_ _I_
  - Sex (Check)
    - Ethnic Origin (Check)
      - Hispanic or Other
        - D.O.B.
          - SSN:
            - FBI: INS
            - Other:

**CHARGES CATEGORY OF CHARAGES(S):**
- **FELLOW**
  - MISSIONMEANOR
  - CLIVAL CONTEMPLT
  - MATERIAL WITNESS OTHER

**CHECK CATEGORY OF CHARAGES(S):**
- **FELLOW**
  - MISSIONMEANOR
  - CLIVAL CONTEMPLT
  - MATERIAL WITNESS OTHER

**DATE OF OFFENSE:** ___ Date of Arrest: ___ Place of Arrest: ___

**State of Birth**
- Country of Birth
  - Citizenship
    - Current Address
      - Zip Code

**Height**
- In: Weight
  - Hair
    - Eyes
    - Scars / Marks / Tattoos

**Injuries / Medication**

**Arraigned Y** Sentenced Y N Special Handling: Y or N Remarks:

**IN** IN IN IN

**Remanding Official (Name) Sign** Agency/District Phone/24 Hour Number

**Print** Print Print

**OUT** OUT OUT OUT

**Removing Official (Name) Sign** Agency/District Phone/24 Hour Number

**Print**

## FOR BOP USE ONLY

**Receiving Official (Name) Sign** Date / Time Receiving Official (Name) Sign Date / Time Print

**Print**

**Sentry Load Data (Most Initial) Name Search Completed by:**
- Clearance/Separate Checked by:
  - OPTIONAL (USE)
    - ARS Code
    - Add AKA's
    - Credit Card Cash Account
    - Deposit Cash Account
    - Detailers
    - Clothing Bag #

**RIGHT THUMBPRINT**

**Original-for ISN as Remanding-Removal receipt:** Copy-for Control as Removal Receipt (NCTC); Copy-For Removing Official; Copy-for Control as Remanding Receipt (immediate); Copy-INS-Allen in Custody.

This form may be replicated via WP.)

EFTA00109584

# FEDERAL BUREAU OF PRISONS

## ARRESTING DEFICIER WILL COMPLETE ALL REQUIRED DATA ON THIS FORM PREPARED TO COMPLISH TO MECUMACO.

| Name: Last | First | Middle |
| :--- | :--- | :--- |
| AKAK: | | |

**Race (Check)**
- **B** _W_ A _I_
- **M** _F_

**Ethnic Origin (Check)**
- Hispanic or Other

**D.O.B.**
- SSN:

**PHN:**
- INM:

**Other:**

**CHARGES**
**CHECK CATEGORY OF CHANGES(8)**
**MISDEMEANOR.**
**CIVIL CONTEMPLATION**
**MATERIAL WITNESS**

**OTHER**
**NARRATIVE:**
**TITLE:**
**NARRATIVE:**
**TITLE:**

**Date of Offense:** ___ Date of Arrest: ___ Place of Arrest: ___

**State of Birth**
- Country of Birth
- Citizenship

**Current Address:**

**Zip Code:**

**Height In:**
- Weight
- Hair
- Eyes

**Scars / Marks / Tattoos**

**Injuries / Medication**

**Emergency Contact:(Name, Address, Phone Number):**

**Attraigned Y** _N_
**Sentenced Y** _N_
**Special Handling: Y or N**

**IN** ___ IN__ ___ IN__
Remanding Official (Name)
Agency/District
Phone/24 Hour Number

**Print**

**OUT** OUT OUT

**Removing Official (Name)**
Agency/District
Phone/24 Hour Number

**Print**

## FOR BOP USE ONLY

**Receiving Official (Name)**
Date Time
Sign
Print

**Receiving Official (Name)**
Date Time
Sign
Print

**Remanding Official (Name)**
Agency/District
Phone/24 Hour Number

**Print**

**Sentry Load Date (Most Initial)**
ABS Code
Staff Init.

**Name Search Completed by:**
Create Cash Account
Deposit Cash
Benefits Court

**Clearance/Separate Checked by:**
Clothing Bag #

**OPTIONAL USE:**
ABS Code
Staff Init.

**Create Cash Account**
Deposit Cash
Benefits Court

**Clothing Bag #**

Original for JSM as Remanding-Removal receipt; Copy-for Control as Removal Receipt (NCIC); Copy-for Removal official; Copy for control as Remanding Receipt (Timers); Copy-TM-Alien in custody.

This form may be replicated via WP.