EFTA00120664

U. S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

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

| Name: Last Williams | First Harley | Register Number 68283054 |
| :--- | :--- | :--- |
| | | Middle |
| AKAs: | | |

**Race (Check)**
- B W A I Sex (Check)
- M F Ethnic Origin (Check)
- Hispanic or Other D.O.B. 125-70-5507 SSN: FBI: 799731ACS INS: Other:

**CHARGES**
**CHECK CATEGORY OF CHARGES(S):**
- FELONY
- MISDEMEANOR
- CIVIL CONTEMPT
- MATERNAL WITNESS

**OTHER**
- NARRATIVE:
- Title: __ USC: __
- NARRATIVE:
- Title: __ USC: __

Date of Offense: 07/24/18 Date of Arrest: 07/31/18 Place of Arrest: __

**State of Birth NY**
- Country of Birth U.S.A
- Citizenship U.S.A
- Current Address New York, NY Zip Code 10031

**Height Ft: In: 05**
- Weight 136
- Hair 080
- Eyes 180

**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 OUT | Agency/District | Phone/24 Hour Number | |

**Removing Official (Name) Sign Print**

**FOR BOP USE ONLY**

**Receiving Official (Name) 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 Staff Init.
- Add ARS #
- 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