u.s.

Regional Administrative Remedy Appeal

Depllrtment of Justice

Federal Bureau of Prisons

t

Type or use ball·point pen. If atruchmcnts are needed, submit four copies. One copy of the completed
with this appeal.

BP~229( 13)

including any attachments must be submitted

From:
LAST NAME. FIHST. MIDDLE INITIAL

REG. NO.

UNIT

INSTITUTION

Part A· REASON FOR APPEAL

DATE

SIGNATURE OF REQUESTER

Part B - RESPONSE

DATE
REGIONAL DIRECTOR
If dissatisfied with this response. you may appeal to the General Counsel. Your appeal must be received in the General Counsel's Office within 30 calendar
days of the date of this response.

ORIGINAL: RETURN TO INMATE

CASE NUMBER:

Part C • RECEIPT
CASE NUMBER:

=-__------:-::-:

Return to:

=__----

-,,__
LAST NAME, FIRST, MIDDLE INITIAL

SUBJECT

DATE

REG. NO.

UNIT

INSTITUTION

_

SIGNATURE, RECIPIENT OF REGIONAL APPEAL
Bp·230(13)