Central Utnce Aonumstratlve H.emeay Appeal

U.:'l. UeparUllCm 01 .lUSllCC

Federal Bureau of Prisons
I,e

Type or lIse ball-point pen. If anachmcllts are needed. submit foul' copies. One copy each of the completed BP-229( 13) and Bp·230( 13), including ony JtlJchmelJ[s must be submi[[ed with this appeal.
From:

LAST NAME, FIRST, MIDDLE INITIAL

REG. NO.

UNIT

INSTITUTION

Part A· REASON FOR APPEAL

DATE

SIGNATURE Or- REQUESTER

Part B . RESPONSE .

DATE

GENERAL COUNSEL

ORIGINAL: RETURN TO INMATE

CASE NUMBER:

Part C - RECEIPT
CASE NUMBER:

Return to:

_
LAST NAME, FIRST, MIDDLE INITIAL

SUBJECT:

DATE
USP LVN

REG. NO.

UNIT

INSTITUTION
_

SIGNATURE OF RECIPIENT OF CENTRAL OFFICE APPEAL
BP·231113)
JUNE 2002