Commitment to penitentiary; form

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The following form, to be furnished by the county, shall be used in transmitting the required data:

"Commitment of (insert name of person) Circuit Court, County of . To the Mississippi Department of Corrections: You are hereby notified that at the term, 2, of the circuit court, Judge presiding, the following named person was tried, convicted and sentenced to a term in the State Penitentiary, as follows: Name Alias Crime Social Security No. Sex Race Appealed Remarks: Dated , 2. Clerk."

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