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¶