EFTA00109634

BP-S377.058 PRISONER REMAND CDFRM

## U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

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

| Name: Last | First | Middle |
| :--- | :--- | :--- |
| AKAs: | | |

**Race (Check)**
- B _ W _ A _ I

**Sex (Check)**
- M _ F

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

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

**FBI:** XJ1WM49
**INS:** Other:

## CHARGES
### CHECK CATEGORY OF CHARGES(S):
- FELONY
- MISDEMEANOR
- CIVIL CONTEMPT
- MATERNAL 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: 00
In: 180
Weight
Hair
Birk
Eyes
Bro

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
JSMS - 50NY

Phone/24 Hour Number
(212) 771-7100

OUT 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
8/03/19

Releasing Official (Name)
Sign
Print

Sentry Load Data: (Most Initial)
Name Search Completed by:
Clearance/Separate Checked by:

(OFFICIAL USE)
Add ARA's
Create Cash Account
Deposit Cash
Amt.
Detainers
Court
Clothing Bag

RIGHT THUMBPRINT

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

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