linquished Custody Date and Time Accepted llstody Date and Time Signature: 1/14 I i '1 (O-9'• i ..h i "-- Signature: Printed Name/ Printed Natim/Agency: Reason: i t V....1.. 4:, 5 V.c, 40 Reason: Relinquished Custody Date and Time Accepted•Citudody , Date and Time Signature: Signature: P