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Waiver of Parole (PB Form 5-10)

STATE BOARD OF PARDONS AND PAROLES


MONTGOMERY, ALABAMA

DATE: ________________________

TO: ALABAMA BOARD OF PARDONS AND PAROLES

FROM: ________________________________
Inmate’s Name
________________________________
AIS #
________________________________
Parole Consideration Date (Month/Year)
________________________________
Inmate’s Location

Upon interview by the parole officer, I hereby state that I am not interested in a parole, and
it is my decision to serve the remainder of my sentence without parole.

_____________________________
Inmate’s Signature

I hereby certify that the above named inmate does understand and does not want any
further consideration for parole.

_____________________________
Parole Officer’s Signature

Distribution
Bd. of Pardons & Paroles
Parole Officer
Inmate

PB Form 5-10

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