| BP-S377.058 | PRISONER REMAND | CDFRM |
| :--- | :--- | :--- |
| FEB 04 | | |

U. S. DEPARTMENT OF JUSTICE

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

| 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: 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 ___ Remarks:

## IN

IN IN IN IN

Remanding Official (Name) Sign Print

Agency/District Phone/24 Hour Number

## OUT

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 Print

Release Official (Name) Sign Print

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

(OPTIONAL USE)
- ANS Code
- Add AKA-T
- Create Cash Account
- Deposit Cash
- Retailers
- Court
- Clothing Bag #

RIGHT THUMPRINT

Original-for ISM as Remanding-Removal receipt; Copy-for Control as Removal Receipt (NCIGs Copy-For Remo q Official); Copy-for Control as Remanding Receipt (Invite); Copy-INS-Allen in Custody.



EFTA00109695