SOP 222.03-att-3: International Transfer Certified Case Summary for State Inmate
Summary
Key Topics
- international transfer
- inmate transfer
- case summary
- certified summary
- inmate records
- parole eligibility
- release date
- sentence information
- criminal history
- inmate data
- transfer approval
- inmate administration
Full Text
Attachment 3
IIB17-0001
3/01/04
# Georgia Department of Corrections Certified Case Summary for State Inmate
Submitting State: ______________________________________
Date: _________________________________________________
Personal Data:
1. Committed Name and Known Aliases :_________________________________________
2. Prisoner Identification Number:_______________________________________________
3. Date of Birth ( Month, Date, Year: e.g. June 1, 1973):______________________________
4. Marital Status/ Children:_____________________________________________________
5. Place of Birth :_____________________________________________________________
6. Nationality:_______________________________________________________________
7. Employment Prior to Incarceration:_____________________________________________
____________________________________________________________________________
____________________________________________________________________________
8. Current Place of Incarceration:_________________________________________________
Sentence Data and Criminal History Information:
1. Sentence Imposed:__________________________________________________________
2. Date Sentence Imposed:______________________________________________________
3. Sentencing Court:___________________________________________________________
4. Criminal Docket Number:____________________________________________________
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5. Current Offense: ___________________________________________________________
6. Description and Date of Offense: ______________________________________________
7. Fines/ Assessments/ Restitution: _______________________________________________
8. Prior Record: _______________________________________________________________
9. Detainers/ Pending Charges/ Pending Appeals: ____________________________________
10. Good Conduct Time, Statutory Good Conduct Time or Other Beneficial Credits That Serve
to Advance the Prisoner’s Release from the Full Term: ________________________________
11. Parole Eligibility Date: ______________________________________________________
12. Projected Release Date: _____________________________________________________
13. Full Term Date of Sentence: __________________________________________________
14. Time Served to Date: _______________________________________________________
15. Credit Received for Time in Custody Prior to Service of Sentence:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Social Data
1. Psychological Evaluation: ____________________________________________________
2. Security Level: _____________________________________________________________
3. Educational Background: _____________________________________________________
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4. History of Alcohol/ Drug Abuse:
____________________________________________________________________________
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5. Current Medical Condition: ___________________________________________________
7. Prison Work Experience: ____________________________________________________
8. Special Program Participation: ________________________________________________
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Other Pertinent Information: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Prepared By: _________________________________________________________________
Name/ Date
_________________________________________________________________
Title/ Phone Number
__________________________________________________________________
Reviewed By: ________________________________________________________________
Name/ Date
_________________________________________________________________
Title/ Phone Number
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Wardens recommendation:
a. Do you recommend international transfer for inmate? ______________________________
Comments:
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Signature / Date
Inmate Administration Manager Review / Recommendation:
________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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Signature / Date
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Facilities Division Director Review / Recommendation:
______________________________________________________________________________________
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Signature / Date
Commissioners Review / Approval:
________________________________________________________________________
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Signature / Date
Retention Schedule:
To be maintained in an inactive file by the Inmate Administration Manager or designee for three years.
Copy: Inmate Administrative File
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