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.”