"Emergency Contact Information Form (Offender)" - Idaho

Emergency Contact Information Form (Offender) is a legal document that was released by the Idaho Department of Correction - a government authority operating within Idaho.

Form Details:

  • Released on December 2, 2014;
  • The latest edition currently provided by the Idaho Department of Correction;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Idaho Department of Correction.

ADVERTISEMENT
ADVERTISEMENT

Download "Emergency Contact Information Form (Offender)" - Idaho

Download PDF

Fill PDF online

Rate (4.8 / 5) 18 votes
IDAHO DEPARTMENT OF CORRECTION
Emergency Contact Information Form (Offender)
In the case of a medical emergency or death, the Idaho Department of Correction (IDOC) will make
notifications based on the information you provide on this form. IDOC will begin with the primary and then
secondary contacts. Once IDOC has made contact with one of your emergency contacts, no further contacts
will be made. It is up to the person contacted to contact the remainder of your family or friends. If no one
listed on this form can be contacted, IDOC will attempt to locate your next of kin or an approved visitor.
Periodically, IDOC will ask you to complete a new Emergency Contact Information Form to ensure your
primary and secondary contact information remains up-to-date. However, it is your ultimate responsibility to
update the information you provide on this form should there be changes.
Primary Contact:
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Secondary Contact #1:
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Secondary Contact #2:
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Property Disposal Information:
In the event of my death, I name the following individual or charitable organization (limited to one
designation) to receive my property and any remaining money I have left in my Offender Trust Account after
all expenses have been settled. Any remaining money will be mailed to the designated individual or
charitable organization in accordance with SOP 114.03.03.011, Offender Trust Account.
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Offender Name:
IDOC Number:
(print)
Offender signature:
Date:
Witness
Name:
Associate (employee) #:
(print)
Witness signature:
Date:
Property (Non-money) Pick Up Signature:
Date:
Distribution: Original to central file; Copy to offender
(updated 12/2/2014)
IDAHO DEPARTMENT OF CORRECTION
Emergency Contact Information Form (Offender)
In the case of a medical emergency or death, the Idaho Department of Correction (IDOC) will make
notifications based on the information you provide on this form. IDOC will begin with the primary and then
secondary contacts. Once IDOC has made contact with one of your emergency contacts, no further contacts
will be made. It is up to the person contacted to contact the remainder of your family or friends. If no one
listed on this form can be contacted, IDOC will attempt to locate your next of kin or an approved visitor.
Periodically, IDOC will ask you to complete a new Emergency Contact Information Form to ensure your
primary and secondary contact information remains up-to-date. However, it is your ultimate responsibility to
update the information you provide on this form should there be changes.
Primary Contact:
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Secondary Contact #1:
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Secondary Contact #2:
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Property Disposal Information:
In the event of my death, I name the following individual or charitable organization (limited to one
designation) to receive my property and any remaining money I have left in my Offender Trust Account after
all expenses have been settled. Any remaining money will be mailed to the designated individual or
charitable organization in accordance with SOP 114.03.03.011, Offender Trust Account.
Name:
Relationship:
Address (physical):
Address (mail):
Home phone:
Cell phone:
Work phone:
Offender Name:
IDOC Number:
(print)
Offender signature:
Date:
Witness
Name:
Associate (employee) #:
(print)
Witness signature:
Date:
Property (Non-money) Pick Up Signature:
Date:
Distribution: Original to central file; Copy to offender
(updated 12/2/2014)