## $$
9 / \sqrt {1 0} \frac {3 0}{\mathrm {p m}}
$$

<table><thead><tr><th rowspan="2">COUNT AREA</th><th rowspan="2">CENSUS</th><th colspan="14">OUT COUNT</th></tr><tr><th>A</th><th>P</th><th>F</th><th>P</th><th>P</th><th>H</th><th>M</th><th>R</th><th>S</th><th>TR</th><th>V</th><th>OC</th><th></th><th></th></tr></thead><tbody><tr><td></td><td></td><td>T</td><td>N</td><td>N</td><td>N</td><td>S</td><td>O</td><td>S</td><td>&amp;</td><td>A</td><td>N</td><td>I</td><td>UO</td><td></td><td></td></tr><tr><td></td><td></td><td>T</td><td>J</td><td>Y</td><td>Y</td><td>S</td><td>S</td><td>D</td><td>N</td><td>W</td><td>S</td><td>TU</td><td>N</td><td>VERIFY</td><td>COUNT</td></tr><tr><td></td><td></td><td>Y</td><td></td><td></td><td>E</td><td>S</td><td>P</td><td></td><td>I</td><td>D</td><td>I</td><td>T</td><td>T</td><td>COUNT</td><td>COUNT</td></tr><tr><td>B-A</td><td>26</td><td>.

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<table><thead><tr><th></th><th>REG #</th><th>NAME</th><th>UNIT</th><th></th><th>REG #</th><th>NAME</th><th>UNIT</th></tr></thead><tbody><tr><td>1.</td><td>89673-053</td><td>Marsey</td><td>KS</td><td></td><td>13.</td><td></td><td></td></tr><tr><td>2.</td><td>91349-029</td><td>Noboa</td><td>KS</td><td></td><td>14.</td><td></td><td></td></tr><tr><td>3.</td><td>85377-054</td><td>Lu-bau</td><td>KS</td><td></td><td>15.</td><td></td><td></td></tr><tr><td>4.</td><td>86272-034</td><td>Montois</td><td>KN</td><td></td><td>16.</td><td></td><td></td></tr><tr><td>5.</td><td></td><td></td><td></td><td></td><td>17.</td><td></td><td></td></tr><tr><td>6.</td><td></td><td></td><td></td><td></td><td>18.</td><td></td><td></td></tr><tr><td>7.</td><td></td><td></td><td></td><td></td><td>19.</td><td></td><td></td></tr><tr><td>8.</td><td></td><td></td><td></td><td></td><td>20.</td><td></td><td></td></tr><tr><td>9.</td><td></td><td></td><td></td><td></td><td>21.</td><td></td><td></td></tr><tr><td>10.</td><td></td><td></td><td></td><td></td><td>22.</td><td></td><td></td></tr><tr><td>11.</td><td></td><td></td><td></td><td></td><td>23.</td><td></td><td></td></tr><tr><td>12.</td><td></td><td></td><td></td><td></td><td>24.</td><td></td><td></td></tr></tbody></table>

This form must be submitted to the Counts and Assignments Officer FORTY-FIVE MINUTES PRIOR to the affected count. Prepare this form in ink. Group the inmates according to their respective housing units. This form is to be used only as an Out-Count. No other form will be accepted in lieu of the Out-Count Form.

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