Application For Parole

Date:

Prisoner's Name:

Prisoner's Number:

Prisoner's Address:

City and Zip:

To: Pennsylvania Board of Probation and Parole
3101 North Front Street
Harrisburg, PA

Gentlemen:

Application for parole is hereby made for the above named prisoner. His/her minimum sentence has expired and, pursuant to 61 PaCS 331.1 et seq. and Marshall v Board, 162 Pa Cmwlth 256, 638 A2d 451; and/or Pierce v Board , 406 A2d 1186 (relating to parole violators) I request that the prisoner be seen and heard by a DISTRICT SUPERVISOR in person within 6 months of his last review.

Submitted By:

Name:

Address:

City and Zip:

Relationship if any:

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