SOP 222.04-att-5: FORM III_ Certificate of Inmate Status

12/15/07 Attachment 5
SOP IIC06-0001
Page 1 of 2
# FORM III AGREEMENT ON DETAINERS

In the case of an inmate's request for disposition under Article III, copies of this Form should be attached to all copies of Form II. In the case of a request
initiated by a prosecutor under Article IV, a copy of this Form should be sent to the prosecutor upon receipt by the warden of Form V. Copies of this Form
should be sent to all other prosecutors in the same state who have lodged detainers against the inmate. A copy may be given to the inmate.

# CERTIFICATE OF INMATE STATUS

RE:
(Inmate) (Number) (Facility) (Location)

The (custodial authority) hereby certifies:

1. The term of commitment under which the inmate above named is being held:

2. The time already served:

3. Time remaining to be served on the sentence:

4. The amount of good time earned:

5. The date of parole eligibility of the inmate:

6. The decisions of the Board of Pardons and Paroles relating to the inmate: (if additional space is needed, use reverse side)

7. Maximum expiration date under present sentence:

8. Detainers currently on file against this inmate from your state are as follows:

Date:
Warden

# CUSTODIAL AUTHORITY

Name:

Facility:

Address:

City/State:

Telephone No.:

12/15/07 Attachment 5
SOP IIC06-0001
Page 2 of 2

Summary Description of FORM III

Function:

1) States the length of time the inmate is expected to remain in custody in Georgia.

2) States the maximum length of time the inmate will remain incarcerated, under his or her currently
active sentences.

3) Lists all detainers against the inmate from the requesting state.

Requirements:

1) If the inmate requests disposition using FORM II, complete FORM III and attach it to all copies of
FORM II.

2) If a prosecutor requests temporary custody of an inmate using FORM V, complete FORM III and
send it to the requesting prosecutor. Send copies of the completed FORM III to all other prosecutors
in the same state who have lodged detainers against the inmate.

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