-x, 72-6 2..o z i Y Date and Time Signature .5h3 h Sigiature: &SA, 1.1-O,m Printed N ri> k ..'-.p.-1 Printed N Reason: Reason: Re, e,v, j Aro nquished Custody Date and Time Accepted Custody Date and Time Signature: Signature: Printed Name/Agency: Printed Name/Agency: Reason: Reas