UNITED STATES COURT OF APPEALS DISTRICT OF COLUMBIA CIRCUIT 333 Constitution Avenue, NW Washington, DC 20001-2866 Phone: 202-216-7000 | Facsimile: 202-219-8530 WARDEN RECEIPT FORM Instructions to the Warden These instructions are intended to provide guidance to prison authorities unable to deliver correspondence to an inmate on behalf of the United States Court of Appeals for the D.C. Circuit. If situations occur which do not fall within these guidelines, the court would appreciate a written explanation of the circumstances. INMATE HAS BEEN RELEASED If the inmate has been released, please return the correspondence to this office. Please include the forwarding address and any other pertinent information so that the court can contact the person. For example, the name/ phone number/office location of the supervising probation or parole officer would be helpful. INMATE HAS BEEN TRANSFERRED If the inmate has been transferred to another facility, please forward the mail to that institution. In addition, please notify this court in writing as follows: "Correspondence from your court dated in , (Docket #) , (Caption of Case) on by was forwarded to (Name of Facility) ." (Date Sent) (Name of Prison Official) INMATE REFUSED TO ACKNOWLEDGE RECEIPT If the inmate refuses to sign for the material from the court, the correspondence should still be delivered as legal mail. The acknowledgment copy of the court's letter should be returned to this office with a notation as follows: "Inmate Refused to Sign - Material Given to by on (Name of Inmate) (Date) ." (Name of Prison Official) RULES DO NOT ALLOW PRISON OFFICIALS TO OBTAIN ACKNOWLEDGMENT If institution rules do not permit officials to obtain an ACKNOWLEDGMENT of receipt of the court's material, the correspondence should be delivered as legal mail. The ACKNOWLEDGMENT copy of the court's letter should be returned to this office with a notation as follows: "Unable to obtain ACKNOWLEDGMENT due to Institution Rules - Material Given to by on (Name of Inmate) (Date) ." (Name of Prison Official) INMATE DECEASED/ESCAPED If an inmate has died while a resident of your facility, or escaped, please return the material to this office with the following notation: "Inmate [Deceased or Escaped] on (Date) ." USCA Form 91 August 2009 (REVISED) American LegalNet, Inc. www.FormsWorkFlow.com