3P-8377.05¢ PRISONER REMAND corny & uv . -S. DEPAR OF TI B OF ARRESTING OFFICER WILL COMBE DATA ON THIS FORM PRIOR TO "MCO/MDCs. : Name: Last Race (Check) BW _A tr Sex (Check) M_oF Ethnic Origin (Check) — Hispanic or 4” Other CHARGES CHECK CATEGORY oF CHARGES (S) : FELONY MISDEMEANOR CIVIL CONTEMPT MATERIAL WITNESS .. . ” —— —_— a OTHER hy . ay, i Vag Vu , 7 a “| en iar NARRATIVE: use ‘ A / / itle: a — “A NARRATIVE: “ > Title: usc } Date of Offense: Date of Arrest: _ Place of Arrest:.. ~ State of Birth Country of Birth Citizenship | Current Address Height 7 Weight fists [even | Scars / Marks / Tattoos ts n: Zip Code . Injuries / Medication Emergency Contact: (Name,- Address, Phone Number) ; Aryaigned Sentenced Special Handling: Yor oN Remarks: Phone/24 Hour Number Remanding Official (Name) Sign Print TF Be ark oo} ee Removing Official » (Name) Sign > aa Phone/24 Hour Number Print Receiving Official (Name) Date / Time Sign Date / Time Releasing..Of ficial (Name) Sign ty Print Print & gentry Load Data: (Must Initial) (OPTION. USE) @ Name Search Completed by: ARS Codej ‘ Staff Init. Add AKA‘ - —_ Clearance/Separate Checked by: Create Cash Account Deposit Cash —___ Ant. —___ Detainers _—_ Court —_ | Clothing Bag # —_ | Original-for ISM as pepapding-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-S277/5Q) ana onsen. EFTA00109695