EFTA00109624

| | | |
| :--- | :--- | :--- |
| BP-S377.058 | PRISONER REMAND | CDFRM |
| FEB 04 | | |

MCC

# U.S. DEPARTMENT OF JUSTICE  FEDERAL BUREAU OF PRISONS

## ARRESTING OFFICER WILL COMPLETE ALL REQUIRED DATA ON THIS FORM PRIOR TO COMMITTING TO MCC/MDCs.

| Register Number | |
| :--- | :--- |
| 83074-0511 | |

**Name:** Last
**BACEZ-PENA**

**First:** Middle

## AKAs:

| Race (Check) | Sex (Check) | Ethnic Origin (Check) | D.O.B. | SSN: | FBI: INS: Other: |
| :--- | :--- | :--- | :--- | :--- | :--- |
| _B_W_A_I_ | _M_F_ | _Hispanic or _Other | | | |

## CHARGES

### CHECK CATEGORY OF CHARGES(S):
- FELONY
- MISDEMEANOR
- CIVIL CONTEMPT
- MATERIAL WITNESS

### OTHER

#### NARRATIVE:
Title: ___ USC:___
NARRATIVE:
Title: ___ USC:___

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

State of Birth | Country of Birth | Citizenship | Current Address | Zip Code |
| :--- | :--- | :--- | :--- | :--- |
| 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 Remarks:

IN IN IN IN

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

OUT OUT OUT OUT

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

FOR BOP USE ONLY

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

Sentry Load Data: (Must Initial) Name Search Completed by: (OPTIONAL USE) ARS Code Staff Init. Add AKA's Create Cash Account Deposit Cash Ant. Detainers Court Clothing Bag

Original-for ISM as Remanding-Removal receipt; Copy-for Control as Removal Receipt (MCIC); Copy-For Removing Official; Copy-for Control as Remanding Receipt (Inmate); Copy-INS-Allen in custody.

(This form may be replicated via WP) This form replaces BP-S377(58) and BP-377(58) of JUL 91