“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 ____
Race ____
Appealed ____
Remarks:
____
____
____
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