^he3V*tero*r ^eXArS
"Sxas I^V)E \T^BS^G«ff
\_£>€^\i^ U)KlWl
MA
fiPfe^sd^o ^ ^^^^^^^^^^^^^^^^^ ^ 4Stuuuhioe*
houston, texas
WR^7~2015-
H^ok\ W fyfe&wA c£ Ifote: (teMisy bfe^uW -CHRISfTOPHER-ArPRlNE
JV^
kA *&W^^
j^to&a\A&^^ __
\&V5l£_(
„\b t$feAeQS )&&5ofr Q^siLcfeod^ON)VcA Met(fofcjp) \]^\ A^AbulA fee 4lfrJkl\ WyU
HqWA\ (Of€(tfae\pA»^g: \ldv(fec\^L^^eiQ $gflE5
c£ VgWi fe?cVjA ydu^ W\\A^S\e^Xu)^^
died.(b&^cg ^doAtri °v ^BEi
)-
JjL*fytibOw\ ^jySk iMMu
CEwV^feL W
mfe^L
Texas Department of Criminal Justice OFFICE USE ONLY
Grievance #:
^gA^^^vpA d£j£ ^\V^JfV^j
r-^r>_)AA^VN
5fi
gs^wyiuA(^5Z^-\Offflk Uwl WyNc^A^T^FflfW. toaSSS^^S^^
WM^^^fc fo VW*W-vs*A f_M(
ythrtkfoft. ^k^f^^K^N^ \ti fcAfcL... ...., -... -v. : ..,. ........ : ...... .., ....... ...............
'yfegXKn
1-127 front (Revised 11-2010) YOUR SIGNATURE IS REQUIRED ON BACK OF THIS FORM (OVER)
Appendix F
OFFICE USE ONLY
Texas Department of Criminal Justice Grievance #:
UGI Reed Date:
STEP 2 OFFENDER HQ Reed Date:.
GRIEVANCE FORM
Date Due:
Offender Name:. TDCJ#JMM. Grievance Code:.
Unit: %MftJDV\^V Housing Assignment: C-~ \ 'b —?J~> -"f? Investigator DD#:.
Unit where incident occurred: KlfvLlX Un> yr Extension Date: _
You must attach the completed Step 1 Grievance that has been signed by the Warden for your Step 2 appeal to be
accepted. You may not appeal to Step 2 witha Step 1 that has been returnedunprocessed.
Give reason for appeal (Be Specific). / am dissatisfiedwith the response at Step 1 because...
hwujfyiNia?vSfovKr) ifo; finduj u^fvrS V-^ toy
fauoWinN^
fag^l") f)&»&p feea>Qh\ VrA»v\ HnW^v\ ^VM.S^Aq^ yA Kn^S ft t^xvWs I \l —W » * V A ' U -^>irf iu£ 2=—I »i -T ^ r i W » V ~
rVrthlHftU dRaotee, fen^ey ^ Kct g& %,T[fcAft W^\'W\rAetfM CStsL)))z.$m fete
frftrS. M\1S5J ^ ^far, j^^ifXJuh^ Mfiuhcij) £^^^^£ JSKfe
XQlfji
^^ ^ IMI' ^ / "VWYi^y N 1-1 v^, ^ »n 1 j_g - _ _ #
1-128 Front (Revised 11-2010) YOUR SIGNATURE IS REQUIRED ON BACK OF THIS FORM (OVER)
Appendix G
Wfemlfo iPAifefei »w ,%#*****;*», Rawest*****5 .
. 02-.APR 2015 -PW SI: ^'""^—
jFiflST La' ' 1
i HCUSU.
•3^\^omk1 S"Vc5
\WrO K) jTJL 77D0 V
CHRISTOPHER A. PRINE
CLERK.
..;#».
*:'••%.• ? i'00220&&93 fli|.|-|ll>il*j».||i|j'l>j|f|ll(l'J||l|J|jllf|||'|'I"|||l|i>lli'l
,j£
Offender Signature : VO Date: Crtfo^flUS
Grievance Response:
Signature Authority:
Returned because: *Resubmit this form when corrections are made. OFFICE USE ONLY
Initial Submission CGO Initials:.
LJ 1. Grievable time period has expired. DateUGIRecd:
LJ 2. Illegible/Incomprehensible.* Date CGO Reed:
(check one) Screened Improperly Submitted
LJ 3. Originals not submitted. *
Comments:
LJ 4. Inappropriate/Excessive attachments.*
Date Returned to Offender
LJ 5. Malicious use of vulgar, indecent, or physically threatening language. 2"1 Submission CGO Initials:
DateUGIRecd:
LJ 6. Inappropriate.*
Date CGO Reed:
(checkone) Screened Improperly Submitted
Comments:
CGO Staff Signature: Date Returned to Offender:
3d1 Submission CGO Initials:
DateUGIRecd:
Date CGO Reed:
(checkone) Screened Improperly Submitted
Comments:
Date Returned to Offender:
1-128 Back (Revised 11-2010) Appendix G
8fo frM B AvW? kg ft
Action Requested to resolve your Complaint,
^n^^rtp^'o ^YxV^rto
Offender Signature: YO-MXK ggjnjg^
Grievance Response:
Signature Authority: , Date:
If you are dissatisfied with the Step 1 response,you may submit a Step 2 (1-128) to the Unit GrievanceInvestigator within 15 days from the date of the Step 1 response.
State the reason for appeal on the Step 2 Form.
———^————n-nmw——~ '• a—— —^— ~~^——^—i ^ ^—f^—— ^gsa=ganHHHHHHHHHzHHHHHHHHBBaeaBsjBgs=^=
Returned because: *Resubmit this form when the corrections are made.
[~11. Grievable time period has expired.
I~l 2. Submission in excess of 1 every7 days. * OFFICE USE ONLY
Initial Submission UGI Initials:
Q 3. Originals not submitted. *
Grievance #: .
I 14. Inappropriate/Excessive attachments, *
Screening Criteria Used: _
|~1 5. No documented attemptat informal resolution. *
Date Reed from Offender:
n 6. No requested reliefis stated. *
Date Returned to Offender:
n 7. Malicious use of vulgar, indecent, or physically threatening language. *
l^SHbjnissifia UGI Initials:.
T~l 8. The issue presented is not grievable. Grievance #: . -
f~l 9. Redundant, Referto grievance # Screening Criteria Used:
l~l 10. Illegible/Incomprehensible. * Date Reed from Offender:
C] 11. Inappropriate. * Date Returned to Offender:
UGI Printed Name/Signature: - S^ubmission UGI Initials:.
Grievance #:
Application of the screening criteria for this grievance is not expected to adversely Screening Criteria Used:
Affect the offender's health.
Date Reed from Offender: _
Medical Signature Authority: Date Returned to Offender:
1-127 Back (Revised 11-2010)
Appendix F