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Case Number
*
Defendant Name
*
Defendant Contact Information
Defendant Phone
*
Defendant E-mail Address
*
Email Unknown
Unknown
Phone Unknown
Unknown
Conviction(s)
*
Transfer Information
State To Which Defendant Requests Transfer
*
-Select a state-
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
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New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
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Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Reason for Transfer
*
Address in Receiving State
*
Others Residing at Address (separated by comma)
*
Is the defendant employed in the receiving state?
*
Yes
No
Employment
Employer Name
Employer Address
Employer Phone
Employer Supervisor (Full Name)
How long have you been employed here?
Does the defendant have additional employment?
Yes
No
Employer #2 Name
Employer #2 Address
Employer #2 Phone
Employer #2 Supervisor (Full Name)
How long have you been employed here (2nd job)?
Any Additional Info You Would Like To Provide
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