OPROB 22 (R ev. 2/88) D O C K E T N U M B ER (Tran. Court) TRANSFER OF JURISDICTION N A M E A N D A D DR ESS O F PR OB ATIO N ER /SU PER VISED RELEA SEE D ISTR IC T D O C K E T N U M B ER (Rec. Court) D IV ISIO N N A M E O F SEN TEN CIN G JU D GE DA TES OF PROBA TION / SU PERV ISED RE LEA SE FROM TO O FFENSE PART 1 - ORDER TRANSFERRING JURISDICTION U N ITED STA TES D ISTR IC T C OU RT FO R TH E D ISTR IC T O F IT IS HEREBY ORDERED that, pursuant to 18 U.S.C. 3605, the jurisdiction of the probationer or supervised releasee named above be transferred with the records of this Court to the United States District Court for the upon that Court's order of acceptance of jurisdiction. This Court hereby expressly consents that the period of probation or supervised release may be changed by the District Court to which this transfer is made without further inquiry of this court.* Date *This sentence may be deleted in the discretion of the transferring Court. PART 2 - ORDER ACCEPTING JURISDICTION U N ITED STA TES D ISTRICT CO U RT FO R T H E D ISTRICT O F United Sates District Judge IT IS HEREBY ORDERED that jurisdiction over the above-named probationer/supervised releasee be accepted and assumed by this Court from and after the entry of this order. Effective Date United States District Judge American LegalNet, Inc. www.USCourtForms.com