Date Submitted: 451*020 
Hamilton County Sheriff?s Office Date Reviewed: 
Corrections Date Assigned:
Inmate Grievance Date Due:

 

Date Returned:

 

 

Inmate's Name: ID Number: Housing Location: Date of Grievance:
Wart/6W 
Nature of Grievance: 3: was draw; 7 NC ?fr 0 53 flu. Flam
cuw-? WM Wag ?4 
af/ awe/c Wake/adders MM 

Wm 
0

cu. 9-55 Jack?) a 6min mm;

Eat/camp.?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Received: a Unit Manager: M7
5f?
Comments:
Date Referred: To:
Date Received: Action Taken: 

 

 

 

 

 

 

 

 

 

Inmate?s Signature

 

Department Head Signature: Date Returned to Classification Dept.:

 

 

Date Received by Classifications Dept:

 

Completed Grievance Sent to: File Date:

 

 

 

 

(Rev.10/16]