Code of Maine Rules › 03 - DEPARTMENT OF CORRECTIONS › 201 - DEPARTMENT OF CORRECTIONS/GENERAL › Chapter 1 - DETENTION AND CORRECTIONAL STANDARDS FOR COUNTIES AND MUNICIPALITIES › Section 201-1-II - COUNTY JAILS › Appendix 201-1-II a-F - ADMISSION AND RELEASE FORM

Current through 2024-29, July 17, 2024
NAME
_____________________
					 _________________________________ ________________
Last First Middle
___________________________________________________________________________
ISA ID CODE INMATE NUMBER/MITT: OTHER ID
					 NUMBERS/MITT:
___ __ _____ _______________________
					 _____________________________
___________________________________________________________________________
DATE AND TIME OF ADMISSION SOCIAL SEC. # SEX DATE OF
					 BIRTH
_____/______/____ ______________ ____________ __Male
					 ______/_____/____
Month Date Year Hours Time (military) ___Female Month
					 Date Year
____________________________________________________________________________________________
COMMITTING AUTHORITY ADMITTING OFFICER
__________________________ ________________
					 _____________________________________________
Name of Agency/Organization Name of Officer Name of
					 Admitting Officer
____________________________________________________________________________________________
OFFENSE/CHARGE(S) - List most serious CRIME STATUS AT
					 ADMITTING DATE
first, with bail or sentence CLASS
1.____________________________________ _______ _____
					 Pre-arraignment ____/____/___
2.
________________________________
				  ______ _____ Post-arraignment ____/____/___
3.
________________________________
				  ______ _____ Pre-Sentence ____/____/___
___ # of additional offenses (separate page) Hold for
					 Court_________________ Other _______________________
__________________________________________________________________________________________
HOME ADDRESS
___________________ _____________________________
					 _______ _______ ____ ____________
Street/Box City/Town State Zip Phone
					 Number
___________________________________________________________________________________________
ALIASES PLACE OF BIRTH EDUCATION
____________________
					 ____________________
City/Town/State Last Grade Completed
____________________________________________________________________________________________
RACE ___ Spanish MARTIAL STATUS __ Single EMPLOYED"
					 ___ Yes ___ No
__ Caucasian __ Black __ Divorced __ Married
					 Employer___________________________
__ Oriental __ Indian __ Separated __ Widowed Length
					 of Employment_______________
_______________________________________________________________________________________
WEIGHT
lbs.
HEIGHT
BUILD
COMPLEXION
HAIR COLOR
EYE COLOR
IDENTIFICATION MARKS
NOTIFY IN CASE OF EMERGENCY ADDRESS:
_______________________________ _____________
					 ___________________________ _________
Name Phone City/Town State
____________________________________________________________________________________________
COURT DISPOSITION (Final; Blank if unknown) (Describe
					 additional offenses on separate sheet)
Offense Date Disposed Describe
					 Disposition
1.
______________
				  _________________________________________________________________________
2.
_______________
				  _________________________________________________________________________
3.
_______________
				  _________________________________________________________________________
DATE AND TIME OF RELEASE RELEASING OFFICER
					 CLASSIFICATION
_____/____/_____ _________ ___________________
					 Security Category
Month Date Year Hour Name Min. Med. Max.
					 Date
Time (military) Initial ___ ___ ___/___/___
Reclass ___ ___ ___/___/____
__________________________________________________
					 Reclass ___ ___ ___/___/____
REASON(S) FOR RELEASE Reclass ___ ___
					 ___/___/____
Reclass ___ ___ ___/___/____
__________________________________________________
					 Reclass ___ ___ ___/___/____
PROBLEMS AND/OR SPECIAL NEEDS DURING
CONFINEMENT