EFTA00109759¶
FEDERAL BUREAU OF PRISONS¶
CDFRM¶
| ARRESTING OFFICER WILL COMPLETE ALL REQUIRED DATA ON THIS FORM PRIOR TO COMMITTING TO MCC/MDCs. | Register Number | PICTURE | |||||
| 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: | ||
| CHECK | CATEGORY OF CHARGES(S): |
|---|---|
| ___ | FELONY ___ MISDEMEANOR |
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) |
| Arrained Y | Sentenced N | Special Handling: _Y or _N |
|---|---|---|
| IN | IN | IN |
| Remanding Official (Name) Sign Print | Agency/District | |
| OUT | OUT | OUT |
| Removing Official (Name) Sign Print | Agency/District |
FOR BOP USE ONLY¶
Receiving Official (Name) Sign Print¶
Date / Time Sign Print¶
Releasing Official (Name) Date / Time Print¶
Sentry Load Data: (Must Initial) Name Search Completed by:¶
Clearance/Separate Checked by: [OPTIONAL USE] ARS Code Add AKA’s Create Cash Account Design Cash Account 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¶