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'-bo #k*)td .lifikvJ ZeAff S.UBjjIECT: State briefly theproblem on which you desire assistance.

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Name: %®X tx&ki No: gssfL Unit: E& Living Quarters: j^^brk. Work Assignment Sdl DISPOSITION: (Inmate will not write in this space) S4tvT^2- (a?CVS C^C^l/iJl <J\)

&I-60 (Rev. 11-90) L-C~0 U«" K^* TEXAS DEPARTMENT OF CRIMINAL JUSTICE —INSTITUTIONAL DIVISION *'.'" - INMATE REQUESTTO OFFICIAL REASON FOR REQUEST: (Please check one) PLEASE ABIDE BY THE FOLLOWING CHANNELS OF COMMUNICATION. THIS WILL SAVE TIME, GET YOUR REQUEST TO THE PROPER PERSON, AND GET AN ANSWER TO YOU MORE QUICKLY.

1. • Unit Assignment, Transfer (Chairman of Classification, 5. Q Visiting List (Asst. Director ofclassification, Administration Administration Building) Building) • ••'••• 2. • Restoration of Lost overtime (Unit Warden-if approved, it 6. Q Parole requirements and related information (Unit Parole will'be- forwarded to the State Disciplinary Committee) Counselor) 3. HJ Request for Promotion in Class or to Trusty Class 7. • 'Inmate Prison Record (Request for copy of record,-infor (UnitWarden- ifapproved, will be forwarded to the Director. mation on parole eligibility, discharge date, detainers-Unit of Classification) Administration) 4. •. Clemency-Pardon, parole, earlyout-mandatorysupervision 8. • Personal Interview with a representative of an outside (Board of Pardons and Paroles, 8610 Shoal Creek Blvd. agency (Treatment Division, Administration Building) Austin, Texas 78757)

TO: uw Uhud (Name and title of official) DATE: zj/daefr ADDRESS,:,