BP-S377.058 PRISONER REMAND corem FEB 04 U.S. DEPARTMENT OF TI Bi OF PRI CHARGES CHECK CATEGORY OF CHARGES (S): .FELONY MISDEMEANOR CIVIL CONTEMPT ~ MATERIAL WITNESS... . OTHER pA € » CLL mi va? ales Wi VWiam.) Title: usec: Date of Offense:____.CdDaatte Of Arrest:, NARRATIVE: Title: US! Place of Arrest:, State of Birth Country.of Birth | Citizenship | Current Address Zip Code... Height - : Weight [es fee Scars /:Marks’/ Tattoos ti n: Injuries / Medication ‘- ' Frergency Contact: (Name,’ Address, Phone Arraigned Sentenced _Y EN _yY N Remanding Official (Name) Sign Print Special Handling: Yor oN Remarks: ~~ Agency/District Phone/24 Hour Number Phone/24 Hour Number Removin§/ va a p Agency/ District Sign Print Ae b of? ‘Receiving Official (Name) Date / Time Releasip P pettciat (Name) Date /- Time sign Sign ¢} ie Fhra dG pove Print ' Print. 5 5» \ y qi Sentry Load Data: (Must Initial) ~ | (OPTIONALAUS Name Search Completed by: ARS Code. , Staff Init. . Add AKA’S5 Tlearance/Separate Checked by: RIGHT THUMBPRINT 3 Create Cash- Account. > Deposit Cash Amt. Detainers Court : Clothing Bag # : t ee i Original-for ISM.aS Remanding-Removal receipt; Copy-for. Control as\ Removals ‘Receipt. (NCIC}# sOopy-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-S37.7(58) and BP-377(58) of JUL 91 @_.. . EFTA00120669

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