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                                      Texas Department of Criminal Justice
                                                                                                                                                      Grievance #:.
                                                                                                      OFFENDER
                                                                                                                                                      Date Received;.
                                       STEPl                                              GRIEVANCE FORM
                                                                                                                                                     "^ateDiie:        r

                                                                                                                                                      Grievance Code: .

Offender Name:                                             S.-7.                          ^              TDCJ #                                       investigator ID

Unit:                                                       Housing Assipnment:^^^/g^'t>?'^' ^ /"2 3~^                                                Extension Date:

Unit where incident occurred: A') /T.                                                                                                                 Date Retd to OiTender;.




You must try to resolve your problem with a staff member before you submit a formal complaint. 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


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1-127 Front (Revised 11-2010)                                YOUR SIGNATURt IS REQUIRED ON BACK OK THIS FORM                                                                                  HOVER)


                                                                                                                                                                                          Appendix F
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                                                                                                                                               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
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