Module 40/41: Post Release Supervision Violator (PRSV) - Revoke/Restore (Willard)

First Name (replace)
Last Name (replace)
NYS ID# * (replace)
DIN # (optional)
Prior Sentence yrs mts
Prior Sentence Jail Time days
Post Release Supervision yrs mts
Prior Sentence Date Received at DOCCS
Prior Sentence Date Paroled
Date Declared Delinquent
Parole Warrant Lodged
Today's Date*
Parole Jail Time days