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Criminal Resource Manual

604. Form—Request for Provisional Arrest

International Extradition

Request for Provisional Arrest

  1. Name of fugitive:

  2. Case caption (if the fugitive is not the principal defendant in the case):

  3. Date discussed with OIA and name of OIA contact:

  4. Prosecutor responsible for this request (name, telephone number, fax number, E-mail address):

  5. Case agent (name, agency, telephone number, pager number and fax number):

  6. Name, telephone number, and fax number of State extradition official who authorized payment of all expenses required to complete extradition (State requests only):

  7. List all charges for which extradition will be sought (name and statutory citation):

  8. Warrant information (name of court (district and division), docket number, name of judge or magistrate who signed the warrant, date of warrant):

  9. Description of fugitive:


    date of birth:

    place of birth:

    citizen of:

    passport number/date and place of issue:

    other identity documents:





    other identifying features:

  10. Location of fugitive (full address and/or telephone number; names and addresses of associates, etc.) and any contact in the foreign country aware of fugitives's location (Name, title, telephone and pager number.):

  11. Facts of case. [Using a narrative style, provide sufficient information, including date and place of offense, to establish probable cause that a crime was committed and that the fugitive committed it. Choose simple, descriptive language that you might use in an affidavit in support of a warrant application, not the formal or statutory language of a formal charging document. Continue on a separate sheet if necessary.]

  12. Prosecutor's certification. [A statement by the prosecutor acknowledging that if the fugitive is arrested it will be necessary for extradition documents to be prepared according to the terms of the relevant treaty. Further, the prosecutor must also certify that those documents will be prepared and sent to OIA according to the schedule set by the OIA attorney.]

[cited in USAM 9-15.230]