Housing Solicitation

Applicant's Name: __________________________________

Address: __________________________________________

Address: __________________________________________

To (name): ________________________________________

(address): _________________________________________

(city, state, zip): ____________________________________

I am eligible for parole as of (date) ___________ from (prison name) SCI- ______________________________. I'm seeking a place to live when I'm released. I will be under strict supervision by the Pennsylvania Board Of Probation and Parole and will strictly obey the law and the provisions of my rental agreement. I will occupy the premises for at least ___________ months.

If you are willing to provide accommodations for me, please complete and return the enclosed (I)Housing Conformation Form (pform2). In turn, I will include it in my Parole Plan to the Parole Board.

Respectfully Submitted:

(sign) _____________________________________________