ed Custody Date and Time Signature: Printed N Reason: (1-k-,Inncterir to C51('T 5r /3 a) I it 6 can Signature: Printed Name/Agency: Reason: Retinquillieti Custody Date and Time Accepted Custody Date and Time Signature: Signature: Printed Name/Agency. Printed Name/Agency: Reason: Reason: Relinquished