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The onlyexception is when appealing the results of a disciplinary hearing. \Vhodi(itwwtdV<1bA0iifi:,title)? lA/n f 'M When? //^/ 'Zy-^/^C'JC What was their response? A< What action was taken? AJtJJr'. Of>. Tr-"* • A -NOV n ? 2015 State your grievance in the space provided. Please state who, what, when, where and the disciplinary ease number if appropriate On ^ra-A/ ^yrrr A^f.ju^^yyn .—r/Vi^e/il>^r7yr AjfAjf ^ y>yroL/y_r yjAfif-i y Af>A/y. /N/.c Z^./f/r^- < y^i-T- ^ Ayrrr-^/y/P— , Z ^ L- -•- " " — Sy-f-TT —^ 7y> ^ / 'sy.u/ nA /y\i m ATd ^ t '' f jt y nc} CJtry . j^Di\ .TNia ^ 'yy}j,y., yx-'ytT '>x~f^y y/> ^(.4^^/^ rl /zsyty ^y>iL-rT7- ... , ,.. - A/>nTNyr ^ A^yy ^ yp '>,yityy>-ry /yy^jyu,' y^ray^y-o •7^ ~y Ajy> -4-^ y^A'rTA} ^'£> /?g ^yA/j£'^ S. A-k 7- f3>.yj^y= ^ .yrpA^jy ^r-rt?rVt—^251 U /'^ Zi2. A/'it.y ^ 'Ty/yPH— e A y<.A-> y r/ A.yy' '^^yy y/->/.,jy^. /T, c Amyy T^N/'c jQ ^ a /y y> y^^r.-7.f.. 7:>3 /f^y yy,y.jyr^ /d>/^-2C> J i 1-127 Front (Revised 11-2010) YOUR SIGNATURt IS REQUIRED ON BACK OK THIS FORM HOVER) Appendix F / /3'^ /=^3/r T'AV,'- 7n rz' ^ . /,^///C /te^- V^ T<>^r. /V/V/^.SC THc'nc A ^ ^ r>^.' A/^ aXj-tt /9/v ~7~^ct ^/? /^ci/.-T- /Pi:rT^iy^<;7"e y-'/Q/? 's . T .^) /^.fT- /OtTx. y^y.ruyr />./> £>.y.-'^ yui jy z^^ /Tf /V^/>7 "ly /'_ ^/\^/>,y/;< TTC/y ^ /C^^Zcxr myyy,n^yj.- />(;yt^.< y-^uhy-c yjy^,-^ /^c^4c'S yA/T rOiy?^ AyrzfiA^j^/^jy>y,y yjl 7n Ndv 0 2 2015 Action Requested to resolve your Complaint. ^ 'yi/{ A/r-T" y^ye-y j X"/: ^'rJ--^/Oy'~/% y//'•t •^u^y^y^T'—y^/yy A/^y.-p • y'C'./ny^ yttUf Offender Signature:^ Date: /' C-/ Grievance Response: Signature Authority: Date: Ifvuu arcdi«sativlicd »iththc.Slcp I response.)you may submit 8Slep 2(1-128) (o the Unit Grievance Investigator nithin 15 days from the dale ofthe Step I response. Stale the reason for appeal on the Step 2 Form.] Returned because: *Resubmit this foym when the corrections arc made. • l Grievable time period has expired. n 2. Submission in excess of I every 7 days. OFFICE ^SE ON liiilini :>tibtnission luGI Iniiials f~l 3. Originals not submitted. • Grievance #: • 4. Inappropriate/Excessive ultachments. Screening Criteria Used: r~l .5. No docuinenled attempt at infcnnal res:ilution. wmrrn Dale Reed from Offender; • 6. No requested relief is slated. * Date Returned lo Offender: -NOV 0 2 2015 • 7 Malicious use ofvulgar, indecent, or piVsically threatening language. Z'^&MlUBiSSimi -UCI Initials:. n 8. jrhgiinHie'prdSehte'J'is not ^evable Grievance #: iyi 9. Redundant, Referiogrievance Screening Criteria Used: si Dale Reed from Offender: Q 11! Inappropfiaie. ^ Date Returned to Offender: ij\ UGI Printed Name/Signature: au-aiUunihSM uci initials:. Grievance S: Application of tlie screening criteria for this grievance is not expected to.adversely Screening Criteria Used:. Affect the offender's health. Date Reed from Offender: Mcdicai Signature Authority:. Dale Returned lo Offender: 1-127 Back (Revised 11-2010) Appendix F Ttf 7^^ ^^a^T/cis 7>^- / n y u ^ o r ^ THb A*ii>nj^JiyCs *t^rH/iAi^s7 <)u^'~^ Co^^TT t>^ f X ^-rr^r^c^ To ^TTi^O jAi.^ Se^:^/^ /ij^Cii/^ y&r ^60< Z' MiT />y j yVd -X^ AfsT Poomto^o yO S £^^i/i' / ^ /^*<}fi^Jdf^ j /V£>7^'0 TirilS ^^y/?Z3^ S>SiOf'^ 0^''^^--CO^>'/p(.i^ 146^0Sa/y ^/V7^ye> ^i'^' 3A'/sr-CA'r3 TP SaoiJ yy^^T X jh/^c Xu74D£//c^ d>^ lyc/X^^s /ZiYJO£/yC£' 0/<=^ Cour>T A^Crjy/jTi> ^/vv? 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