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Name;_^<P^^^//>/>^^>V'^^ No: 767S73/7 Unit: ^^/^C^AA Living Quarters: _7f ^ ~~7S Work Assignment: TffcrAAna/Ayj&Ss/yA/fC&AZf 0) DISPOSITION: (Inmate will not write in this space) y {deck y7°i"eU ^^ 7 ' •fty. fo7' •£1-60 (Rev. 11-90) TEXAS DEPARTMENT OF CRIMINAL JUSTICE— INSTITUTIONAL DIVISION •• - ,. • INMATE REQUESTTO OFFICIAL REASON FOR REQUEST: (Please checkone) ._•-._ v- PLEASE ABIDE BY THE FOLLOWING CHANNELS OF COMMUNICATION: THIS WILLSAVE TIME, GET YOUR REQUEST TO THE PROPER PERSON, AND GET AN ANSWER TOYOU MORE QUICKLY.

1. -• Unit Assignment, Transfer.(Chairman of Class0ation, 5. d^Vjsiting List (Asst. Director otclassificationjAdministration .Administration Building). Buila^q) 2. -• RestoratibiigfLost overtime (Unityifarden-if approved, it. 6. • Parole, requirements' and rei^fm information (Unit Parole will be forwardetH<ithe Stateptscipiinary Committee). Counselor) 3. • Request for Promotion irf^CMss or to-Trusty- Class 7. • Inmate Prison/tecorcHBequest for copy of record, infor-' (UnitWarden- ifjgpproved,.will be^warded to the Director mation op^parofeeligibijity^dischargeidate, detainers-Unit of Classification) AdmiTstration) A.- Q 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: 7^7 AT^AP 72777 DATE: 3 - JlS-/<? (Name and title ofnfficial) ADDRESS: SE^y-e//y 77%?A