PRISONER REMAND

U. S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

# ARRESTING OFFICER WILL COMPLETE ALL REQUIRED DATA ON THIS FORM PRIOR TO COMMITTING TO MCC/MDCa.

| Name: Last | First | Middle | D.O.B. | SSN: | FBI: INS: Other: |
| :--- | :--- | :--- | :--- | :--- | :--- |

## AKAs:

| Race (Check) | Sex (Check) | Ethnic Origin (Check) | D.O.B. | SSN: | FBI: INS: Other: |
| :--- | :--- | :--- | :--- | :--- | :--- |
| B _ W _ A _ I | M _ F | Hispanic or _ Other | | | |

## 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 _ N Remarks:

| IN | IN | IN | IN | IN |
| :--- | :--- | :--- | :--- | :--- |
| Remanding Official (Name) Sign Print | Agency/District | Phone/24 Hour Number | | |
| OUT OUT OUT OUT OUT | Agency/District | Phone/24 Hour Number | | |

Removing Official (Name) Sign Print | Agency/District | Phone/24 Hour Number | |

## FOR BOP USE ONLY

### Receiving Official (Name) Date / Time Sign Print

### Releasing Official (Name) Date / Time Sign Print

### Sentry Load Data: (Must Initial) Name Search Completed by: Clearance/Separate Chocked by: ___

(OPTIONAL USE)
ARS Code ___ Staff Init.___
And AKA Y ___
Create Cash Account ___
Deposit Cash ___ Amt.___
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

EFTA00120653

Prepared on: 07/31/2019



SOUTHERN NEW YORK
District 54


Prisoner Remand or Order to Deliver

<table border="1"><tr><td colspan="5">PRISONER REMAND OR ORDER TO DELIVER AND RECEIPT FOR UNITED STATES PRISONERS(SHORT FORM)</td></tr><tr><td>TO:</td><td colspan="3">MCC New York</td><td>DATE: 07/31/2019</td></tr><tr><td colspan="4">THE FOLLOWING NAMED UNITED STATES PRISONERS:</td><td>[X] are herewith remanded to your custody[ ] are to be delivered to representative presenting and signing this order</td></tr><tr><td>#</td><td>USMS NO.</td><td>Local Jail No.</td><td>Name</td><td></td></tr><tr><td>1</td><td>76318054</td><td></td><td>EPSTEIN, JEFFREY</td><td></td></tr></table>

RECEIPT

THE ABOVE NAMED PRISONER(S) WERE RECEIVED:

BY:

TITLE: CSO.

DISTRICT OR ORGAN. ADDRESS:

UNITED STATES MARSHAL

BY: DEPUTY U.S. MARSHAL

Limited Official Use

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