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 2024-38, September 18, 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 ____/____/___

___ # 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_______________

_______________________________________________________________________________________

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

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