| 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. |
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¶