“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. The sentence was suspended and the person was placed on probation:
Name ____ Alias ____
Date of sentence ____ Crime ____
Term of sentence ____ Sex ____
Race ____ Appealed ____
Remarks: Give brief summary of crime committed. ____
____
____
____
Dated ____, 2____. ____ Clerk.”
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