Waiver of Appearance

• Legal Form Number: BP-A0495
• Date: 2010-06
• Year: 2010
• Section: Federal Bureau of Prisons

U.S. DEPARTMENTOF JUSTICE

FEDERAL BUREAU OF PRISONS

BP-A0495

JUN 10 WAIVER OF APPEARANCE

Facility

Name/Register No.

I,, have

been advised of my right to appear before the (specify)

(CDC, UDC, DHO, SRO)

on. I do not wish to appear, and I hereby waive that right.

Inmate Signature

Register Number

Staff Member Printed Name/Signature/Date

Witness:

I saw inmate

Inmate Name/Register No.

at

Time/DateSpecific location, e.g. Room No.

at

and advised the inmate of the right to appear before the (specify)

CDC, UDC, DHO, SRO

on

Date

.

The inmate declined to appear at the hearing, but refused to sign a Waiver of Appearance.

Staff Member Printed Name/Signature/Date

Second Staff Member Printed Name/Signature/Date

PDF

Prescribed by P7310

(Replaces BP-495 of MAR 91.)