SOP 222.04-att-13: FORM VI_ Evidence of Agent's Authority to Act for Receiving State

12/15/07 Attachment 13
                                     SOP IIC06-0001
# FORM VI AGREEMENT ON DETAINERS

Five copies. All copies, with original signatures by the prosecutor and the agent, should be sent to the Administrator of their own state. After signing all copies, the Administrator should
retain one for his/her files, send one to the warden/superintendent of the facility in which the prisoner is located and return two copies to the prosecutor who will give one to the agent for
use in establishing his/her authority and place one in his/her files. One copy should also be forwarded to the Agreement Administrator in the sending state.

EVIDENCE OF AGENT'S AUTHORITY TO ACT FOR RECEIVING STATE
TO:

is confined in
(Inmate name and number)

(Facility) (Address)

and will be taken into custody at the facility on or about

for return to the County of, State of for trial.

In accordance with Article V(b), I have designated
whose signature appears below as agent to return the inmate.
Date:
(Prosecuting Official)
Title:

County:

Address:
(Agent's signature)
City/State:

Telephone No.:
(Agent's signature)

TO: Warden/Superintendent

In accordance with the above representation and the provisions of the Agreement on Detainers, the persons listed above are

hereby designated as Agents for the State of to return to the

County of, State of for trial.

At the completion of the trial,

shall be returned to the

Date:

Agreement Coordinator:

Address:

City/State:

Telephone No.:

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