EFTA00109764¶
U.S. DEPARTMENT OF JUSTICE¶
APRIVING OFFICER WILL COMPLETE ALL REQUIRRED DATA ON THIS FORM PRIOR TO COMMITTING TO RECOMMENDATION.¶
Name: Last CONTENT¶
First¶
Middle¶
PETITION¶
AKAa:¶
Race (Check) B W A I Sex (Check) M F Ethnic Origin (Check) Hispanic or Other D.O.B. SSN: FEMININE OTHER:¶
CHANGES CHECK CATEGORY OF CHARGES(S): MISDEMEANOR CIVIL CONTEMPLATION MATERIAL WITNESS OTHER¶
NARRATIVE: Title: USC: 951 NARRATIVE: Title: USC: 951¶
Date of Offense: ___ Date of Arrest: ___ Place of Arrest: ___¶
State of Birth Country of Birth Citizenship Current Address Zip Code¶
Weight Pt. In: Weight Hait 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¶
Removing Official (Name) Sign Print¶
Agency/District Phone/24 Hour Number¶
FOR BOP USE ONLY¶
Receiving Official (Name) Sign Print¶
Date / Time Receiving Official (Name) Sign Print¶
Sentry Load Data (Hunt Initial) Name Search Completed by: Clearing/Separate Checked by:¶
UTILITY USE: ARS Code And AKA a Cash Account Deposit Cash Container 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 (Imate); Copy-INS-Allen in Custody.¶
This form may be replicated via WP)¶