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(Cnntinuu¢inu)

V.<)iuntary Statement of: §`&{(Zm¢m[§z§ §g\_[lgg [3§{§?€/_ j
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n Pé n Pr~inlad Nuno -
On this the 2 ’dz;y of éwl ?D/D b A

mary Public 111 md For 'I`he Sme of Te)os:
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'I~O; ~ - ` Dacc: ___ ____'_____.____ `_ ___
` _ OfficialStatement ~ ‘ . ' _

 

|n aécordnnce with BP 03.77. you arc required to participate in r_hc investigation into the allegations specified /\ddress each nl|egntinn or claim eomp|etdy. Do nm
respond with indefinite answers such ns "| don’t know" or "l have no knowledge ot". `|f you have no knowledgc, explain wh)" _\'uu do nnr. (| was on vncan'on; l did nn¢
wn_rk rhnt dny. ctc.) Makc sure your answers are fnctu:d, professionnj, and cnmplete. I)n nm include opinions or unrelated comments. Rcmcmber. the Dimctor. Of!ice
of r.hc lnspccmr Gcncml"(OlG). and/or Fedcral Coun (Jt`ficia|.\ mn)' nevic\y your responsc. All grievances arc confidential and may not be discussed between you :\r`u!
the offender or with any orher person. _ ‘ ' ' l '
Ynu ate expected m return this investigation within'ten (lO) working days of receipt. Ynu must sign and date the statement when completed and return ic to the Unit
(`.n'evance ()t'fice. lf you were provided n photocopy of the grievance, it must also be renamed to the Unir Gr_ievance Offii:e. The grievance may not bc duplicated or

shared with the accused staff membcr.
P|ease Provide the Following Documents_

Part|cipaut(s) Statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_[]

l Cl Witness(es)Statement (signed) ~ l-
IJ Activity Logs (ilecreatlon, Shower. Feeding) D Ot'he_r 4 . l
Ci_ f Shift §oster - z l U z Life|il Danger Investigation_
[] _ lngt'ess/Egress Log' [J lnve_ntor'y Sheets
U Con"scation Sheet C] `Pr'operty Logs
ALLEGAT|ONS:
SUMMARY OF Ol;`FENDER INTE_RVIEW:
EMPLOYEE STATEMENT:
slc;NAfruRE ' ' ' ' .‘ , ‘DATE ' _' 4 _ `

R.j\NK/I`lTLE - ' SHlFTlDEPARTMENT

' PmNTEo NA_ME ' ' '
' suPEvasoRs coMMEN_Ts:`jZ@ ,

   

 

 

 

 

 

sulFT/DEPARTMENT

ocm(ua<lon¢v 912007 ' _` \ '_ ~ . - App¢mtlx H"

 

 

 

 

 

W»QH 1 1a ¢@WM _. §§ 5%7¢
_'Section".Xs'.:‘Additionai lnf~orrr{at,lort . . . ' ` ' -’ -.

Note the demeanor of th`e victim during investigation:

 

 

 

dealt/w

Does the victim or assa|iant exhlbtt characteristics/demeanor of the Opposite gender? identify .as either Assaiiant or Victim. a M'

Property search of offc nders identified as assailants? ENQ [:]Yes If yas, identify by name and TDCJ# those searched

Did offender make contradictory statements? |f §es, describe: A/O

Were there any medically verified or noted injuries at time of_initia| interview? MNo [:lYes

if yes, describe:

 

 

 

 

 

 

   
  

   
 

 

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g Unabie to Sub`stantiate Subject's Allegations

'S<St. 15 13me _ 0‘7-7_3 03

[:] Substantiated Sttbject’s A|_|egations

 

;Rt‘(%. ém\ow~_'

lnvestigator’§ Printed Name |rtvestigator's Signatttre gate

SPP-OZ (1'ev. 2) (9-15-20Q6) Page,4 of 6

")EQ

§ ,
TDCJ #; ll?§é/é?l/ .

. O_ffénder Narne:

 

Sectio'n -Xtt: investigation R'eview and Récommendations (chec/r all rhaz'App/y)

 

|nitiai Review by Nlajor or Designee

§éonour with investigator's Fi`ndi _s ~ Forward investigation to the UC * - `
Datia Forwarded: - »
Comments:1 `_

  
 

 

§ Non C'oncur with |n\/¢_stig'ator's findings - Forvvard investigation to t_h`e UCC
Date Fon,varded: ` - » ‘ Time Forwarded;---

 

 

 

 

   

 

 

Comments:.
§'Roturn~To |nvestigator~for furth,er"action'- Data_Retumed::»--,_ , ~' ` Time Returned-:
.~ ~ 1 . ._ 1 _ ' %91'/// 713-'"//
1 Major or. Dbsignee Printed Name~'~ ' / ` yé'ior Or |YéSiQnBB SiQnai€re / v Daie

 

Subsequen_t. R`eview§by. Major or-Designee
(On`/y necessary when returned to the /nvest/'gator)

/

§ Co_ncur with lnvestig_ator.’s Findings- F`orward -|nv sti atlon to the UCC
Data Forwarded: 4 - Time Forw rd dc '

Comments: .' _ /
‘ \ ii\./

§'~No_n~Concur with lnvestigator’s findings - Forva d | veé`ig ion"§the UCC
Date Forwarded: . _ _Time ltd r ed:.. _ ,

Comments:

 

 

 

 

 

 

§ Return To Investigator for fdither action - Date Returned: Time Returned:

_`_

 

ivtajor or Designee Printed Name / ' Major or Designee Signature Daté

 

 
 

Roquest for Extension

I:] Extension Requeated: y_o I:]Yes' Justification::

 

 

 

 

Warden or Designee Approving Extension: ' ' . /
Major or Designee Printed Name Major or Designee Signature l ' ' pate
Sectto_n‘Xil| U_C_C Revi_ew and Recommendatton " /: ~.' .. _1 '~ =' ' ~ /_ "

 

 

[]Housing Change l:]Job Change [:]Unit Transfer (Z]{Safekeeping []Ad. Seg. PC iZ/emain CurrentStatus

Referring to the table in Sect/'on /// above, indicate by number the offenders that need to be marked as enemies based on the
investigation: n

JCC observations of offender demeanor: d/

iustiHcation for recommended decision by UCC: wi .. W;Z,S‘ § r&¢~#d{' tcr M//b£ /l/&F M/
)ate Forwarded to SCC. " ' ' ' ca%£rf M~/OM(.M . /Lm" {/‘zZDT

 

 
 

 

iCC Chairperson's Printed Name _ UCC'Chairperson's Signature z gate .

;PP-oz (rev_. 2) (9-15-2006) c Page 5 nra

')¢:0

(B) tdCOlmgm - PASSPORT Thursday, December 17, 2015, 5:16:07 AM

 

CSINIBOZ/CINIBOZ TEXAS DEPARTMENT OF CRIMINAL JUSTICE 12/17/15
lMGM/DDA4458 IN~FORMA-PAUPERIS DATA 05:15:42
TDCJ#: 01354674 SID#: 05601473 LOCATION: BILL CLEMENTS INDIGENT DTE: 07/30/10
NAME: FINLEY}JAICOURRIE DEWAYNE BEGINNING PERIOD:

PREVIOUS TDCJ NUMBERS:

CURRENT BAL: 0.00 TOT HOLD AMT: 0.00 BMTH TOT'DEP:

6MTH DEP: 6MTH AVG BAL: 6MTH AVG DEP:

MONTH HIGHEST BALANCE TOTAL DEPOSITS MONTH HIGHEST BALANCE TOTAL DEPOSITS

PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION
NO BANKING ACTIVITY
WITHIN THE PAST 6
MONTH PERIOD.

STATE OF TEXAS COUNTY OF /)@ ,;-
oN TH:S THE QDAY OF e¢ , ,QQU'J: CERTIFY THAT THIS DOCUMENT IS A TRUE,

COMPLETE,AND UNALTERED COPY MADE BY ME OF INFORMATION CONTAINED IN THE
COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIG:
PFl-HELP PF3-END ENTER NEXT TDCJ NUMBER: OR SID NUMBER:

 
 
 
   
 

  

K. HOLT
NoTAnv Puauc,
sTATE 01= TExAs

y , 1a mm1sxp1s 09-30-2016
NQTAHY WlTHOUT BOND

/47%»

   
 

   

