SOP 503.02-att-6: Residence Verification Form: Georgia Department of Community Supervision, Department of Corrections, and/or Board of Pardons and Paroles

SOP 503.02
Attachment 6

1/30/20
Page 1 of 2

# Residence Verification Form: Georgia Department of Community Supervision, Department of Corrections, and/or Board of Pardons and Paroles Probationer Parolee

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Full Name: ____________________ Last__________________ First ______Middle Suffix
Date of Birth: MM____ DD____ YYYY________
Institute Released From: _________________________
Date Released: MM __________DD________ YYYY_______ (this form is valid for 60 days
from this date)

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Residence Address Provided Upon Release:
Street Address: _____________________________
City_____________________ State_____________ Zip Code __________________
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Mailing Address Provided Upon Release (if different from Residence Address):
Mailing Address ______________________________
City_________________________ State________________ Zip Code ________________

Signature of Probationer /Parolee _______________________Date ______/____ /______
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ATTESTATION OF D.C.S., D.O.C. or PAROLE BOARD OFFICIAL
I hereby attest that the residence address listed above was verified by a site visit from a
Department of Community Supervision Officer, Corrections Official or Parole Official.
_____/_____/_____

Signature of D.C.S, D.O.C., or Parole Board authorizing official Date
Notary: _____________________________________

Sworn to and subscribed before me this: _________day of _____________________20_____________.
___________________________________
Notary Public
Seal

Retention Schedule: Upon completion, the original shall be given to the offender at release, and a copy shall
be placed in the TOPPSTEP packet in the offender’s institutional file.

SOP 503.02
Attachment 6

1/30/20
Page 2 of 2

DDS 752 10/07 DDS 752 10/07
Instructions for D.O.C. or Parole Official

(Community Supervision Officer, Correctional Facility Official or Pardons and Parole
Official):
This form shall serve as proof of residency documentation for inmates being released
from a Georgia Department of Corrections Facility on probation or parole. This form
may be used to satisfy the residency requirement for issuance of a Georgia Driver’s
License or Identification Card. The D.C.S., D.O.C. or Parole Official should complete
this form and provide the original form to the inmate being released. The released
individual may then present this form as proof of residency in order to comply with
Georgia Administrative Comp. Ch. 375-3-1-.02. This form is valid for 60 days from the
date of release indicated. If the date of release is not indicated or is more than 60 days
before the license issuance date, the released individual must provide another form of
acceptable documentation to satisfy the proof of residency requirements of Georgia
Administrative Comp. Ch. 375-3-1-.02.

Retention Schedule: Upon completion, the original shall be given to the offender at release, and a copy shall
be placed in the TOPPSTEP packet in the offender’s institutional file.