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NOTIFICATION TO COME BY MAIL ROOM
V% (}fl ‘ UNIT
Inmate NameN ( Date i ( (S
lnrnateNo.HOL4LQ I
The above namdJnmate is required to come to te mail room
f)
(Date and Time)
regarding the following matter:
Questionable Correspondence
Questionable Publication
Package
‘1 Legal, Special, or Media Correspondence
Other
Inmate’s Signature_______________________ Date
Notifying
Officer’s Signature ‘i, . fl 121 (
Original—Return to unit mail room.
Copy—Give completed copy to inmate. I-152