Miss. Code § 99-19-47
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."
Miss. Code § 99-19-47