Court Opinion

ID: 4059654
Source: CourtListenerOpinion
Date Created: 2016-09-29 19:37:40.010832+00
Date Added: 2024-06-11T14:31:57.773619
License: Public Domain

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                          Texas Department of Criminal Justice
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                                                                                             Grievance #:
                                                          OFFENDER
                                                                                             Date Received:
                           S 1 JtLF 1               GRIEVANCE FORM
                                                                                             Date Due:

                                                                                          Grievance Code:

 Offender Name: ^bfiSxhl^Ui^^                                  TDCJ # ^ ^ ?                  Investigator ID #:

 Unit: {_^A-y<Ajg_ 1ca--n-            Housing Assignment: C> ' " » O                         Extension Date:

 Unit where incident occurred: CaxA^iaa "SCcf-H"                                             Date Retd to Offender:

 You must try to resolve your problem with a staff member before you submit a formal complaint. The only exception is when
 appealing the results of a disciplinary hearing.     /             »   0                                         /   / _ /• <"~
•Who did you talk to (name, title)?      ",0 f!AfyO ' K/>ofl*-?<•*                                   «/u„„o
                                                                                                     When?  h" f " ^
 What was their response?
 What action was taken?     tAjft^-

 State your grievance in the space provided. Please state who, what, when, where and the disciplinary case number if appropriate

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 1-127 Front (Revised 11 -2010)       YOUR SIGNATURE IS REQUIRED ON BACK OF THIS FORM                                             (OVER)

                                                                                                                            Appendix F

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