RECEIVED IN Tha Court of Appeals Sixth District APR 0 2 2015 Texarkana, Texas \ Debra Autrey, Clerk Cou{7 of4/A£/?Js -r^ , *. -</-• ^ v- Sixth Wst^ict FILED IN 

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# '5//f^/yiM..Mi-az^SUBJECT: State briefly the problem on which you desire assistance.
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Name:

_ Living Quarters: 

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rs: f-*~ ~5 Jj& Work Assignment: /u&K.x}Qtfl&r OS DISPOSITION: (Inmate will notwrite in this space) 

### ,^AA c \A ^xi £M>0(Rev.11-90) \A^ ^ ^~N -^TEXAS DEPARTMENT OF CRIMINAL JUSTICE

— INSTITUTIONAL DIVISION INMATE REQUEST TO OFFICIAL REASON FOR REQUEST: (Please check one) PLEASE ABIDE BY THE FOLLOWING CHANNELS OF COMMUNICATION. THIS WILL SAVE TIME, GETYOUR REQUESTTO THE PROPER PERSON, AND GET AN ANSWERTO YOU MORE QUICKLY.

TO: 1. M Unit Assignment, Transfer (Chairman of Classification, ^Administration Building) 2. G Restoration ofLost overtime (Unj/Warden-ifapproved, it willbetorwardedto the Statarffsciplinary Committee) 3. G Request foSA^romotfon in Class or to Trusty Class (Unit Warden-itefproved, willbeforwarded to the Director ofClassification) 4. G Clemency-Pardon,paroi&earlyout-mandatorysupervision lard ofPardons and Paries, 8610 Shoal Creek Blvd. f Austin, Texas 78757) 

### Manroo^i 5. Sw Visiting List (Asst. Directorof classification, Administration "BvMr 6. G Parole requirements and related information (Unit Parole Counselor) 7. G Inmate Prison Reoo'rd (requestfor copy ofrecord, infor mation onparpie eligibility, discharge date, detainers-Unit Administration) 8. G Personal Interview with a representative of an outside fncy (TreatmentDivision, Administration Building) 

### ./S^y^'/s DATE:

ADDRESS: {Name anamieoi owaaij *a . ^

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