Prison Release Discharge Form
Please fill out the details for the prison release discharge process.
Full Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inmate ID Number
Date of Admission
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Release
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Release
Discharge Instructions
Signature of Released Individual
Submit
Should be Empty: