SOP 222.03-att-4: International Transfer Prisoner Transfer Notification and Acknowledgment Form

Attachment 4

IIB17-0001

3/01/04
# Georgia Department of Corrections International Prisoner Transfer Notification and Acknowledgment Form

The United States has entered into international treaties with many countries which may
permit a foreign national prisoner from one of the treaty countries to transfer to his home country
to serve the remainder of his sentence. The State of Georgia has enacted legislation which allows
it to participate in the international prisoner transfer program. The transfer program is
discretionary and not everyone who applies will be qualified or will be approved for transfer. To
transfer your application must first be approved by the State. The United States and your home
country must also approve your application before a transfer can occur. If you are unsure whether
your country participates in this program, please contact your case manager or your nearest
consulate for more information. You may also need to contact your consulate to assist you and to
determine if your home country has any additional requirements.

1. Name: ________________________________________________________________
2. Prisoner Number: _______________________________________________________
3. Date of Birth: __________________________________________________________
4. Place of Birth: _________________________________________________________
5. Citizenship: ___________________________________________________________
6. Institution/ Prison: ______________________________________________________
7. Offense: ______________________________________________________________
8. Sentence: _____________________________________________________________
9. Projected Release Date: _________________________________________________
10. Language Preference: ___________________________________________________

I am interested in being transferred to continue serving the sentence imposed by the State of
Georgia to the country of citizenship indicated above. I understand that this is just an inquiry to
obtain data before the actual request for transfer and is not binding upon either the government or
me. I understand that upon approval for transfer, I will be required to attend a verification hearing
before the United States Magistrate Judge. I have indicated above the language preference for my
verification hearing and understand an interpreter will be available if necessary.
Signature: ________________________________ Date: ________________________

I hereby indicate that I am not interested in being transferred to continue serving the sentence
imposed by the State of Georgia to the country of citizenship indicated above.
Signature: ________________________________ Date: _______________________

Retention Schedule:
To be maintained by the Inmate Administration Manager or designee for three years.
Copy: Inmate Administrative File