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D~" RTM llNIS

ADM ISSION/ COMMITAL FORM Committal 7 / ,7 / Date

, REDACTED

Centre

T ' \. Surname Other Names

J BDA Hair Colour: Eye Colour: Heighl:

I .;

Weight :

ems

Admiss ion Time

Previously

Ward D Date of Birth :

.. :m p.m

Tr:.ineeO

Fite No

REDACTED

Religion :

Descr iption Details : Scars· Tattoos : Injuries: Abrasions: Date of Arre~l : I I

P:tronts or Guardians Nolified'

YES D NO D

e l NT"oD

REMAND DETAILS

ADMISSION COMMI T AL DETAILS

OTHER DETAILS

SIGNATURES

/ - , ,

tof I'-

Falhllr : Nome

IBGU Mother : Name

1BGT Informant

-;/""?r and Rank Ho.

Charge: A. V'

Remanded to : . '

Bai l : No l21 v .. D lnf<l'mant and Rank Ho. :

Court :

'c I I

Address

tvl Address

REDACTED

( on : / 1/r": Date Bailed : / /

Probation Officer :

Phone

Phone

REDACTED

fO': Court Haari .. g ~ Sent.,nce 0 Clinic Re s Cl

Surety:

Station:

Date al Hearina:

$ ------------

// Oates of Offence Reason for Admlulon I Offences Set1tencea

Adult Parole

Property·

No D Yes D

List other items: / ( - __________ .J.v...:!~ !£ __ _

This Statement is Correct .

=mJ ___ _ Young Person

Clothing : Condition : V.Good D Est.Value s__________ Average D List ilems : Poor D

_l__!_!.._ __ l..1-...J!? J_ !!...''--~---- ------

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_ ___j_

Escort and Rank No. Rece1v1ng Off cer

SW 803 S -482 COPY 5 - BLUE - REGIONAL SERVICES

DHS.3002.092.0239_R