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¶