EFTA00109674

BP-S377.058 PRISONER REMAND CDFRM

FEDERAL BUREAU OF PRISONS

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

| Name: Last | First | Middle |
| :--- | :--- | :--- |
| AWAs: | | |

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

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

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

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

**FBI:**
- INS:
- 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 Print | Agency/District | Phone/24 Hour Number |

## FOR BOP USE ONLY

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

**Sentry Load Data: (Must Initial) Name Search Completed by:**
- Clearance/Separate Checked by:

[OPTIONAL USE]
ARS Code Staff Init.
Add N/A
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-Allen in Custody.

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

EFTA00109675



EFTA00109676

BP-S377.058 PRISONER REMAND CDFRM

## U.S. DEPARTMENT OF JUSTICE

| ARRESTING OFFICER WILL COMPLETE ALL REQUIRED DATA ON THIS FORM PRIOR TO COMMITTING TO MCC/MDCs. |
| :--- |
| Name: Last | First |
| AKAs: |
| Race (Check) __B__W__A__I | Sex (Check) __M__F | Ethnic Origin (Che __Hispanic or __Ot |
| Last Name CAMACHO |
| First Name FERDINAND |
| Middle Name Suffix 5'07'' | Weight 180 |
| Hair BALD | Eye BLUE |
| Regno 79355-054 | Facility NYM |



## CHARGES

## OTHER

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

<table border="1"><tr><td>State of Birth</td><td colspan="2">Country of Birth</td><td>Citizenship</td><td>Current Address</td><td>Zip Code</td></tr><tr><td>Height
Ft: In:</td><td>Weight</td><td>Hair</td><td>Eyes</td><td colspan="2">Scars / Marks / Tattoos</td></tr><tr><td colspan="4">Injuries / Medication</td><td colspan="2">Emergency Contact:(Name, Address, Phone Number)</td></tr></table>

<table border="1"><tr><td>IN</td><td>IN</td><td>IN</td><td>IN</td><td>IN</td></tr><tr><td colspan="2">Remanding Official(Name)SignPrint</td><td>Agency/District</td><td colspan="2">Phone/24 Hour Number</td></tr><tr><td>OUT</td><td>OUT</td><td>OUT</td><td>OUT</td><td>OUT</td></tr><tr><td colspan="2">Removing Official(Name)SignPrint</td><td>Agency/District</td><td colspan="2">Phone/24 Hour Number</td></tr></table>

FOR BOP USE ONLY

<table border="1"><tr><td colspan="2">Receiving Official(Name) Sign Print Date/Time</td><td colspan="2">Releasing Official(Name) Sign Print Date/Time</td></tr><tr><td>Sentry Load Data:(Must Initial) Name Search Completed by: Clearance/Separate Checked by:</td><td colspan="2">(OPTIONAL USE)
ARS Code___ Staff Init.___
Add AKA&#x27;s ___
Create Cash Account___
Deposit Cash___Amt.
Detainers___
Court___
Clothing Bag#___</td><td>RIGHT THEMBPRINT</td></tr></table>



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