RANT FOR MY ARREST SHALL BE ISSUED. Signature or Delendant Or Anenle and Par nt I Custodian) Dale Sanest HOLD lot other Agency Name: SIgnahre of Arreearta Ceder x Memo Yorificalion (Printed by Arrestee) NIWOV O Ponderous O Resisted Aunt Name of Arresisg Officer (Print) I.D. ii (PRINT) 0 Suicidal 0