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.”