EFTA00109778¶
U.S. DEPARTMENT OF JUSTICE¶
APRERITING OFFICER WILL CONFIRM ALL REQUIREMENTS THIS FORM PRIOR TO COMMITTING TO RECORD/ACCOUNT.¶
Name: Last First¶
AKAes:¶
Race (Check) Sex (Check) Ethnic Origin (Check) D.O.B. SSN: B W A I M F Hispanic or Other FBI: INS Other:¶
CHARGES CHECK CATEGORY OF CHARGES(S): FELLOY MISSEMEANOR MATERIAL WITNESS OTHER¶
NARRATIVEVS: Title: NARRATIVEV: Title: USC: USC: Date of Offense: Date of Arrest: Place of Arrest:¶
State of Birth Country of Birth Citizenship Current Address Zip Code¶
Height In: Weight Hair Eyes Scars / Marks / Tattoos¶
Injuries / Medication¶
Arraigned Y Sentenced Y Remarks: Y or N¶
IN IN IN IN¶
Remanding Official (Name) Agency/District Phone/24 Hour Number Print¶
Out Out Out¶
Removing Official (Name) Agency/District Phone/24 Hour Number Print¶
FOR BOP USE ONLY¶
Receiving Official (Name) Date / Time Receiving Official (Name) Date / Time Sign Print¶
Print¶
Sentry Load Data: (Must Initial) ABS Code Staff Init. Name Search Completed by: ABS Code Create Cash Account Clearance/Separate Checked by: Desert Cash Account Amt. Detainees Court Clothing Bag¶
(OPTIONAL USE) ABS Code Staff Init. Create Cash Account Amt. Detainees Court Clothing Bag¶
RIGHT THUMBRINT¶
Original for IBM as Remaining Removal receipt; Copy-for Control as Removal Receipt (NCIC); Copy-For Removal Official; Copy-for Control as Remending Receipt (Immature? Copy-INS-Allen in Custody). This form may be replicated via WP)¶