EFTA00120665 BP-S377.058 PRISONER REMAND C FEB 04 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.						PICTURE
Name: Last		First		Middle
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
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 Checked by:				(OPTIONAL USE) ARC Code Staff Init. Add REM & Create Cash Account Deposit Cash Amt. Detailers Court Clothing Bag

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 EFTA00120666 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 | SSN: | FBI: INS: Other: | | :--- | :--- | :--- | :--- | :--- | | Race (Check) | Sex (Check) | Ethnic Origin (Check) | D.O.B. | 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: 71 USC: 846 Dangerous Drugs **NARRATIVE:** Title: _ USC:_ Date of Offense: 2/11/2015 Date of Arrest: 3/11/2015 Place of Arrest: ___ State of Birth | Country of Birth | Citizenship | Current Address | Zip Code | | :--- | :--- | :--- | :--- | :--- | | Height Ft: 5 In: 3 | Weight 135 | Hair Blk | Eyes Blue | 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 Remanding Official (Name) Sign Print | Agency/District | Phone/24 Hour Number | | :--- | :--- | :--- | | OUT OUT OUT | OUT OUT OUT | 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 Print | Sentry Load Data: (Must Initial) Name Search Completed by: Clearance/Separate Checked by: | Staff Init. | 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