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¶