EFTA00109679

<table border="1"><tr><td colspan="2">ARRESTING OFFICER WILL COMPLETE ALL REQUIRED DATA ON THIS FORM PRIOR TO COMMITTING TO MCC/MDCs.</td><td>Height</td><td>Weight</td></tr><tr><td rowspan="3">Name: Last</td><td rowspan="3">First</td><td>5&#x27;09&quot;</td><td>160</td></tr><tr><td>Hair</td><td></td></tr><tr><td>BLACK</td><td></td></tr><tr><td></td><td></td><td>Regno</td><td></td></tr><tr><td></td><td></td><td>76328-054</td><td></td></tr></table>



AKAs: NONE

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):
___ FELONT ___ MISDEMEANOR ___ CIVIL CONTEMPT ___ MATERIAL WITNESS

OTHER
NARRATIVE:
Title: __ USC: 549 Poss Drugs
NARRATIVE:
Title: __ USC: 846 Conspiracy

Date of Offense: __ 8/31/19 Date of Arrest: __ 8/31/19 Place of Arrest: __ 8/31/19

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 IN

Remanding Official (Name) Sign Print
Agency/District
Phone/24 Hour Number 646-712-3228

OUT OUT OUT OUT OUT

Removing Official (Name) Sign Print
Agency/District
Phone/24 Hour Number 646-721-0164

FOR BOP USE ONLY

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

Sentry Load Date: (Must Initial) Name Search Completed by:
Clearance/Separate Checked by:

(OPTIONAL USE)
ARS Code __ Staff Init.__
Add AKA'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