SOP 222.04-att-4: FORM II_ Inmate's Notice of Place of Imprisonment and Request for Disposition

12/15/07 Attachment 4
SOP IIC06-0001
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# FORM II AGREEMENT ON DETAINERS

Six copies, if only one jurisdiction within the state involved has an indictment, information or complaint pending. Additional copies will be necessary for prosecuting officials and clerks
of court if detainers have been lodged by other jurisdictions within the state involved. One copy should be retained by the inmate. One signed copy should be retained by the warden.
Signed copies must be sent to the Inter ~~state Detainer Coordinator of Georgia and to the Agreement Administrator of the receiving state, the prosecuting official of the jurisdiction~~
which placed the detainer, and the clerk of the court which has jurisdiction over the matter. The copies for the prosecuting officials and the court must be transmitted by certified or
registered mail, return receipt requested.

# INMATE'S NOTICE OF PLACE OF IMPRISONMENT AND REQUEST FOR DISPOSITION OF INDICTMENTS, INFORMATIONS OR COMPLAINTS

To: Prosecuting Officer,
(Jurisdiction)

, Court
(Jurisdiction)

And to all other prosecuting officers and courts of jurisdictions listed below from which indictments, informations or complaints are pending.

You are hereby notified that the undersigned is now imprisoned in

at
(Facility) (Town and State)

and I hereby request that a final disposition be made of the following indictments, informations or complaints now pending against me:

Failure to take action in accordance with the Agreement on Detainers, to which your state is committed by law, will result in the invalidation of the indictments,
informations or complaints.

I hereby agree that this request will operate as a request for final disposition of all untried indictments, informations or complaints on the basis of which detainers have
been lodged against me from your state. I also agree that this request shall be deemed to be my waiver of extradition with respect to any charge or proceeding contemplated hereby
or included herein, and a waiver of extradition to your state to serve any sentence there imposed upon me, after completion of my term of imprisonment in Georgia. I also agree that
this request shall constitute a consent by me to the production of my body in any court where my presence may be required in order to effectuate the purposes of the Agreement on
Detainers and a further consent voluntarily to be returned to the facility in which I now am confined.

If jurisdiction over this matter is properly in another agency, court or officer, please designate the proper agency, court or officer and return this form to the sender.

The required Certificate of Inmate Status and Offer of Temporary Custody are attached.

Date:
Inmate's Signature

Type:
Inmate's Name and Number

12/15/07 Attachment 4
SOP IIC06-0001
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# AGREEMENT ON DETAINERS: FORM II (Continued)

The inmate must indicate below whether he/she has counsel or wishes the court in the receiving state to appoint counsel for purposes of any proceedings preliminary to
trial in the receiving state which may take place before his/her delivery to the jurisdiction in which the indictment, information or complaint is pending. Failure to list the name and
address of counsel will be construed to indicate the inmate's consent to the appointment of counsel by the appropriate court in the receiving state.

A. My counsel is
(Name of Counsel)

whose address is
(Street, City and State)

B. I request the court to appoint counsel.

I have read the above or have had the above read and explained to me, and I understand its meaning and agree thereto.

Date:
Inmate's Signature

Type:
Inmate's Name and Number

Witness: Date:
Signature

Name and Title

12/15/07

Attachment 4
SOP IIC06-0001

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Summary Description of FORM II

Function:

1) Notifies the prosecuting officer and jurisdiction of the inmate's place of imprisonment.

2) Requests final disposition of pending actions.

3) Serves as waiver of extradition, both for charges pending in the requesting state and for serving any sentences
which may result.

4) Serves as consent to appear in court under the purposes of the Agreement and to return voluntarily to the current
facility of confinement.

5) Indicates whether the inmate has counsel or wishes the appropriate court to appoint counsel.

Requirements:

1) The inmate must complete this form to request final disposition of all indictments, informations, or complaints
held against him in the state which has filed a detainer.

2) If only one jurisdiction has a pending action within the State involved, the facility must produce and distribute
five copies of the complete Form II:

(a) One for the Inmate.

(b) One signed copy for the Warden.

(c) One signed copy for the Central Office Interstate Detainer Coordinator.

(d) One signed copy for the prosecuting official of the jurisdiction which placed the detainer.
Send by certified or registered mail, return receipt requested.

(e) One signed copy for the Clerk of Court which has jurisdiction over the matter. Send by
certified or registered mail, return receipt requested.

(f) One signed copy for the Agreement Administrator of the receiving state.

3) If more than one jurisdiction claims pending action in the requesting state, send a complete, signed Form II to
each prosecuting official and each Clerk of Court in the affected jurisdictions.

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