ustody Date • Time me Signature: is 1.26 I; t Sig; aturc: Printed Na Printed Name/Agen c3sks .t:adt GA . 3 ) ;i''-'1 Reason: k...„v) i Ec/iti ci,i3 i gra • Relinquished Y Date and Accepted:Custody Date and Time Time Signature: Printed N 472 47 Sigrat Primed .1/j/.9O / k ,V Reas