SOP 503.02-att-1: Certification of Prison Records
Summary
Key Topics
- Social Security card
- Social Security Number
- inmate records
- reentry
- identification verification
- SSA application
- prison records certification
- TOPPSTEP
- counselor certification
- personal identifying information
Full Text
# GEORGIA DEPARTMENT OF CORRECTIONS
_Prison_
_Prison Address_
_Warden’s Name_
_Warden_
Brian P. Kemp Timothy C. Ward
_Governor_ _Commissioner_
CERTIFICATION OF PRISON RECORDS
DATE: ________________________________________
INMATE NAME: _______________________________
INMATE ID: ___________________________________
SOCIAL SECURITY NUMBER: ___________________
SOCIAL SECURITY ADMINISTRATION
Street address
City, State and Zip
Attached please find a completed Form SS-5 (Application for Social Security Number) requesting a replacement
Social Security Number card for the above named individual.
I, the undersigned, certify that I have reviewed appropriate documents in the above named inmate’s official prison
record and that the identifying information shown below is accurate to that record:
NAME_________________________________________________________________________
DATE OF BIRTH: _______________________________________________________________
PLACE OF BIRTH: ______________________________________________________________
MOTHER’S MAIDEN NAME: _____________________________________________________
FATHER’S NAME: ______________________________________________________________
Other Names used by Inmate: Other Social Security Numbers used by Inmate:
______________________________ _______________________________
______________________________ _______________________________
______________________________ ________________________________
______________________________ _______________________________
If you have any further questions, please contact me between the hours of 8:00 am to 4:00 pm.
My telephone number is ___________________.
_______________________________
Printed name of Counselor
_______________________________
Signature
OMB Control Number 0960-0688
Retention Schedule: Upon completion, this form shall be placed in the TOPPSTEP packet in the offender’s institutional
file, and the file shall be retained according to the official retention schedule for that file.