SOP 222.04-att-10: Inmate Acknowledgment of Notification of Request for Temporary Custody

                               Attachment 10
                               SOP IIC06-0001
                              12/15/07
                Inmate Acknowledgement of
          Notification of Request for Temporary Custody

Department of Corrections
2 Martin Luther King, Jr. Dr., S.E.
Floyd Building
Twin Towers East, 7th Floor
Atlanta, Georgia 30334

RE: Inmate Name:

    Inmate Number:

This is to certify that I have been advised that there are charges pending against

me in, .
              (County)  (State)

A request for temporary custody has been made under the Interstate Detainer Agreement

to return me to that state for disposition of their charges. I understand that I

have a right to file a Writ of Habeas Corpus in the county in which I am incarcerated.

If I do not file such action within twenty (20) days, I understand that the requesting

state will assume custody of me. I do hereby waive any challenge and agree to return

to the requesting state.
                     ,
                      (Inmate Signature)  (Date)

                         (Inmate Number)

                                    ,
                      (Notary's Signature) (Date)

Warden/Superintendent's Instruction

This form should be completed by the inmate and Release and Agreements Officer
advised of his decision immediately.

Sign below only if the inmate refuses to sign this form.

"INMATE REFUSED TO SIGN FORM.",
                      (Notary's Signature) (Date)

RETENTION SCHEDULE:
Upon completion, a copy of this paperwork will be kept in the inmate case
history file.