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· ;;th;o;r (JJ) I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I , I I \ I ', I I . I \ I '' . 1 / 1 c r z en en :S: Ill c: "'tl :::J 3 m 0 (Q ~ .c.. en 0 m - 0 -1 55 -1 0 ~ ~ z u; :::J a CD ~- TEXA.S DEPARTMENT OF CRIMINAL JUSTICE--- INSTITUTIONAL DIVISION •, .

INMATE REQUESTTO OFFICIAL REASO~J FOR REQUEST: (Please check one) PLEASE ABIDE BY THE FOLLOWING CHANNELS OF COMMUNICATIO~HIS WILL SAVE TIME, GET YOUR REQUEST TO THE PRORER PERSON, AND GET AN ANSWER TO YOU MORE QUICKLY.

1. 0 -:;signment, Transfer (Chairman of Classification, 5. D VisifrRQ_ List (Asst. Director of classification, Administration Administra" n Building) Buildin 2. 0 Restoration of Lo wertime (Unit Warden-if approved, it 6. 0 ents and related information (Unit Parole will be forwarded to th State Disciplinary Committee) 3. 0 Request for Promotion in ~ 7. D Inmate Prison Record uest for copy of record, infor- (Unit Warden- if approved, wiil be to mation on parole eligibility, 1 arge date, detainers-Unit of Classification) Administration) 4. 0 Clemency-Pardon, parole, early out-mandatory supBrrt-ision 8. D Personal Interview with a representative o~ outside (Board of Pardons and Paroles, 8610 Shea/ Creek Blvd. agency (Treatment Division, Administration Building) Austin, Texas 78757)

TO: _d_cttj/ ~nd tit/; o o ;c;at) DATE: 9-1I- I ~ -~A~DDRESS: --- J+cJ 05c/y{/