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3,3 OOGGOOZE

'I~O; ~ - ` Dacc: ___ ____'_____.____ `_ ___ ` _ OfficialStatement ~ ‘ . ' _

|n aécordnnce with BP 03.77. you arc required to participate in r_hc investigation into the allegations specified /\ddress each nl|egntinn or claim eomp|etdy. Do nm respond with indefinite answers such ns "| don’t know" or "l have no knowledge ot". `|f you have no knowledgc, explain wh)" _\'uu do nnr. (| was on vncan'on; l did nn¢ wn_rk rhnt dny. ctc.) Makc sure your answers are fnctu:d, professionnj, and cnmplete. I)n nm include opinions or unrelated comments. Rcmcmber. the Dimctor. Of!ice of r.hc lnspccmr Gcncml"(OlG). and/or Fedcral Coun (Jt`ficia|.\ mn)' nevic\y your responsc. All grievances arc confidential and may not be discussed between you :\r`u! the offender or with any orher person. _ ‘ ' ' l ' Ynu ate expected m return this investigation within'ten (lO) working days of receipt. Ynu must sign and date the statement when completed and return ic to the Unit (`.n'evance ()t'fice. lf you were provided n photocopy of the grievance, it must also be renamed to the Unir Gr_ievance Offii:e. The grievance may not bc duplicated or shared with the accused staff membcr.

P|ease Provide the Following Documents_ Part|cipaut(s) Statement

_[] l Cl Witness(es)Statement (signed) ~ l- IJ Activity Logs (ilecreatlon, Shower. Feeding) D Ot'he_r 4 . l Ci_ f Shift §oster - z l U z Life|il Danger Investigation_ [] _ lngt'ess/Egress Log' [J lnve_ntor'y Sheets U Con"scation Sheet C] `Pr'operty Logs ALLEGAT|ONS: SUMMARY OF Ol;`FENDER INTE_RVIEW: EMPLOYEE STATEMENT: slc;NAfruRE ' ' ' ' .‘ , ‘DATE ' _' 4 _ ` R.j\NK/I`lTLE - ' SHlFTlDEPARTMENT ' PmNTEo NA_ME ' ' ' ' suPEvasoRs coMMEN_Ts:`jZ@ ,

sulFT/DEPARTMENT ocm(ua<lon¢v 912007 ' _` \ '_ ~ . - App¢mtlx H"

W»QH 1 1a ¢@WM _. §§ 5%7¢ _'Section".Xs'.:‘Additionai lnf~orrr{at,lort . . . ' ` ' -’ -.

Note the demeanor of th`e victim during investigation:

dealt/w Does the victim or assa|iant exhlbtt characteristics/demeanor of the Opposite gender? identify .as either Assaiiant or Victim. a M' Property search of offc nders identified as assailants? ENQ [:]Yes If yas, identify by name and TDCJ# those searched Did offender make contradictory statements? |f §es, describe: A/O Were there any medically verified or noted injuries at time of_initia| interview? MNo [:lYes if yes, describe:

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g Unabie to Sub`stantiate Subject's Allegations 'S<St. 15 13me _ 0‘7-7_3 03 [:] Substantiated Sttbject’s A|_|egations

;Rt‘(%. ém\ow~_' lnvestigator’§ Printed Name |rtvestigator's Signatttre gate SPP-OZ (1'ev. 2) (9-15-20Q6) Page,4 of 6 ")EQ § , TDCJ #; ll?§é/é?l/ . . O_ffénder Narne:

Sectio'n -Xtt: investigation R'eview and Récommendations (chec/r all rhaz'App/y)

|nitiai Review by Nlajor or Designee §éonour with investigator's Fi`ndi _s ~ Forward investigation to the UC * - ` Datia Forwarded: - » Comments:1 `_

§ Non C'oncur with |n\/¢_stig'ator's findings - Forvvard investigation to t_h`e UCC Date Fon,varded: ` - » ‘ Time Forwarded;---

Comments:.

§'Roturn~To |nvestigator~for furth,er"action'- Data_Retumed::»--,_ , ~' ` Time Returned-: .~ ~ 1 . ._ 1 _ ' %91'/// 713-'"// Major or. Dbsignee Printed Name~'~ ' / ` yé'ior Or |YéSiQnBB SiQnai€re / v Daie

Subsequen_t. R`eview§by. Major or-Designee (On`/y necessary when returned to the /nvest/'gator) / § Co_ncur with lnvestig_ator.’s Findings- F`orward -|nv sti atlon to the UCC Data Forwarded: 4 - Time Forw rd dc ' Comments: .' _ / ‘ \ ii\./ §'~No_n~Concur with lnvestigator’s findings - Forva d | veé`ig ion"§the UCC Date Forwarded: . _ _Time ltd r ed:.. _ , Comments:

§ Return To Investigator for fdither action - Date Returned: Time Returned: _`_

ivtajor or Designee Printed Name / ' Major or Designee Signature Daté

Roquest for Extension I:] Extension Requeated: y_o I:]Yes' Justification::

Warden or Designee Approving Extension: ' ' . / Major or Designee Printed Name Major or Designee Signature l ' ' pate Sectto_n‘Xil| U_C_C Revi_ew and Recommendatton " /: ~.' .. _1 '~ =' ' ~ /_ "

[]Housing Change l:]Job Change [:]Unit Transfer (Z]{Safekeeping []Ad. Seg. PC iZ/emain CurrentStatus Referring to the table in Sect/'on /// above, indicate by number the offenders that need to be marked as enemies based on the investigation: n JCC observations of offender demeanor: d/ iustiHcation for recommended decision by UCC: wi .. W;Z,S‘ § r&¢~#d{' tcr M//b£ /l/&F M/ )ate Forwarded to SCC. " ' ' ' ca%£rf M~/OM(.M . /Lm" {/‘zZDT

iCC Chairperson's Printed Name _ UCC'Chairperson's Signature z gate . ;PP-oz (rev_. 2) (9-15-2006) c Page 5 nra ')¢:0 (B) tdCOlmgm - PASSPORT Thursday, December 17, 2015, 5:16:07 AM

CSINIBOZ/CINIBOZ TEXAS DEPARTMENT OF CRIMINAL JUSTICE 12/17/15 lMGM/DDA4458 IN~FORMA-PAUPERIS DATA 05:15:42 TDCJ#: 01354674 SID#: 05601473 LOCATION: BILL CLEMENTS INDIGENT DTE: 07/30/10 NAME: FINLEY}JAICOURRIE DEWAYNE BEGINNING PERIOD: PREVIOUS TDCJ NUMBERS: CURRENT BAL: 0.00 TOT HOLD AMT: 0.00 BMTH TOT'DEP: 6MTH DEP: 6MTH AVG BAL: 6MTH AVG DEP: MONTH HIGHEST BALANCE TOTAL DEPOSITS MONTH HIGHEST BALANCE TOTAL DEPOSITS PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION NO BANKING ACTIVITY WITHIN THE PAST 6 MONTH PERIOD.

STATE OF TEXAS COUNTY OF /)@ ,;- oN TH:S THE QDAY OF e¢ , ,QQU'J: CERTIFY THAT THIS DOCUMENT IS A TRUE, COMPLETE,AND UNALTERED COPY MADE BY ME OF INFORMATION CONTAINED IN THE COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIG: PFl-HELP PF3-END ENTER NEXT TDCJ NUMBER: OR SID NUMBER:

K. HOLT NoTAnv Puauc, sTATE 01= TExAs y , 1a mm1sxp1s 09-30-2016 NQTAHY WlTHOUT BOND /47%»