SOP 222.04-att-6: FORM IV_ Offer to Deliver Temporary Custody

12/15/07 Attachment 6
SOP IIC06-0001
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# FORM IV 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 this
Form should be completed after the warden has indicated his approval of the request for temporary custody, expiration of the 30 day period, and/or successful completion of a
(Cuyler) hearing. Copies of this Form should then be sent to all officials who previously received copies of Form III. One copy also should be given to the prisoner and one copy
should be retained by the warden. Copies mailed to the prosecutor should be sent certified or registered mail, return receipt requested.

OFFER TO DELIVER TEMPORARY CUSTODY

Date:

TO:
(Prosecuting Officer)

(Jurisdiction)

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

RE: Number:
(Inmate)

Dear Sir:

Pursuant to the provisions of Article V of the Agreement on Detainers between Georgia and your state, the undersigned hereby offers to deliver temporary custody of the
above-named prisoner to the appropriate authority in your state in order that speedy and efficient prosecution may be had of the indictment, information or complaint which is
(described in the attached

inmate's request) (described in your request for custody of ).
(Date)

(The required Certificate of Inmate Status is enclosed.) (The required Certificate of Inmate Status was sent to you with our letter of ).
(Date)

If proceedings under Article IV(d) of the Agreement are indicated, an explanation is attached.

Indictments, information or complaints charging the following offenses also are pending against the inmate in your state and you are hereby authorized to transfer the
inmate to custody of appropriate authorities in these jurisdictions for purposes of disposing of these indictments, information or complaints.

Offenses County or Other Jurisdiction

___________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

12/15/07 Attachment 6
SOP IIC06-0001
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# AGREEMENT ON DETAINERS: FORM IV (Continued)

If you do not intend to bring the inmate to trial, will you please inform us as soon as possible?

Kindly acknowledge.

Date:
Warden

CUSTODIAL AUTHORITY

Name: __________________________________________

Facility: _________________________________________

Address: ________________________________________

City/State: _______________________________________

Telephone: _____________________________________

12/15/07

Attachment 6
SOP IIC06-0001
Page 3 of 3

Summary Description of FORM IV

Function:

1) Notify the receiving jurisdiction(s) that the inmate will be made available for disposition of pending actions.

2) Informs the receiving prosecutor of other jurisdictions in his state to which he may transfer the inmate for disposition
of other pending actions.

Requirements:

1) If the inmate requests disposition of pending actions using FORM II, attach a completed copy of FORM IV to each
copy of FORM II.

2) If the prosecutor has requested temporary custody using FORM V, complete FORM IV and send it to all recipients of
FORM III. Mail copies to the prosecutor(s) using certified or registered mail, return receipt requested.

3) Give one copy to the inmate.

4) Keep one copy in the inmate's facility file.

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