EFTA01625438.pdf

09/21/09 OFFENDER COP OBLIGATIONS TIME: 16:34:23 OPSB003-XX CHANGE ORDER PAGE: 1 OFFICER NUMBER: 07824 OFFICER NAME: SLOANE, CARMEN DOC NO: W35755 NAME: EPSTEIN, JEFFREY STATUS: ACTIVE P/P ACCT CASE PAYEE ACCT ORIGINAL PAYMENT CURRENT FINAL PFX SEQ CO NUMBER ID NUMBER TYPE COP OBLIG. SUR SCHEDULE BALANCE PYMNT DUE 01 001 50 0809381 1000UNT050 03 C 473.00 Y 0.00 0.00 03/23/10 01 001 50 0809381 33DCDRG000 09 65.00 Y 10.00 65.00 03/23/10 `-1►C. 01 001 50 0809381 33DCTRN001 24 C 24.00 Y 0.00 0.00 07/21/10 01 001 36STPLA001 11 0 600.00 Y 54.55 485.54 07/21/10 OFFICER: DATE: SUPERVISOR: DATE: CJIT: DATE: EFTA01625438  EFTA01625439 FLORIDA DEPARTMENT OF CORRECTIONS TIME: 15:23:16 AS OP: 08/07/09 COURT ORDERED PAYMENTS PAGE: OFFICE: LAKE WORTH OFFENDER FINANCIAL OBLIGATION AGREEMENT OPS0112-02 VERIFICATION DOCUMENT OFFICER: SLOANE, CARMEN OFFENDER: EPSTEIN, JEFFREY DOC NO: W35755SUPERVISION BEGIN DATE: 07/22/09 SCHED TERM DATE: 07/21/10 PAYEE: DEPARTMENT OF CORRECTIONS DRUG TESTING FINAL PAYMENT DUE DATE: PAYEE ID: 33DCDRG000 03/23/10 t PAID Ot ORIGINAL AMOUNT OWED: $65.00 t SUPERVISION REMAINING: PREFIX: 01 NET CHANGE: 92t ACCT SEQ: 001 $0.00DB PAYMENT SCHEDULE: $10.00 TOTAL OBLIGATION: $65.00DB AVERAGE PAYMENT CASE NO: 0809381 UNIF CS#: PAID TO DATE: $0.00 STATUS: $0.00 LAST PAYMENT DATE: 00/00/00 SUSPENDED BALANCE $65.00DB SURCHARGE Y PAYEE: DC OFFICER TRAINING/EQUIPMENT SURCHARGE FINAL PAYMENT DUE DATE: PAYEE ID: 33DCTRN001 07/21/10 % PAID 0% ORIGINAL AMOUNT OWED: $24.00 SUPERVISION REMAINING: PREFIX: 01 NET CHANGE: 92% T SEQ: 001 $0.OODB PAYMENT SCHEDULE: $10.00 ' TOTAL OBLIGATION: SE NO: 0809381 S24.00DB AVERAGE PAYMENT $0.00 UNIF CS#: PAID TO DATE: $0.00 ATUS: DEFERRED LAST PAYMENT DATE: 00/00/00 BALANCE $24.0008 SURCHARGE Y PAYEE: STATE OF FLORIDA COST OF SUPERVISION FINAL PAYMENT DUE DATE: PAYEE ID: 36STFLA001 07/21/10 t PAID Ot ORIGINAL AMOUNT OWED: $600.00 t SUPERVISION REMAINING: PREFIX: 01 NET CHANGE: 92% ACCT SEQ: 001 $0.00DB PAYMENT SCHEDULE: $54.55 TOTAL OBLIGATION: $600.00DB AVERAGE PAYMENT CASE NO: UNIF CS#: PAID TO DATE: $0.00 STATUS: OPEN $0.00 LAST PAYMENT DATE: 00/00/00 BALANCE $600.00DB SURCHARGE Y RECAP ORIGINAL OBLIGATIONS: $689.00 TOTAL SURCHARGE: $27.56 ALL COPS PAYMENTS ARE TO BE MADE PAYABLE TO THE DEPARTMEN TOTAL NET CHANGE: $0.00DB T OF CORRECTIONS (DC), AND ARE TO BE IN GUARANTEED FORM OF PAYMENT SUCH TOTAL PAYMENTS: $0.00 AS A MONEY ORDER OR CASHIER'S CHECK. VISA AND MASTERCARD MAY BE ACCEPTED. TOTAL BALANCE: $716.56DB SURCHARGE DUE: $2.98 PAYMENTS DUE: $74.55 REQUIRED PAYMENT: . ...RIFIED BY OFFIC " DATE: C; - --1 I -.0 9 I UNDERSTAND MY SPECIAL CONDITION(S) TO FULFILL THIS FINANCIAL OBLIGATIONS) PRIOR TO MY SCHEDULED SUPERVISION TERMINATION DATE(S) AS ORDERED BY THE SENTENCING AUTHORITY, AND ACKNOWLED GE RECEIPT OF A COPY OF THIS FINANCIAL OBLIGATION AGREEMENT. FAILURE OLATION OF SUPERVISION. OFFENDE DATE: I I r / 07/24/09 OFFENDER COP OBLIGATIONS TIME: 08:35:52 0PSB003-XX CHANGE ORDER PAGE: 1 OFFICER NUMBER: 07824 OFFICER NAME: SLOANE, CARMEN DOC NO: W35755 NAME: EPSTEIN, JEFFREY STATUS: ACTIVE P/P ACCT CASE PAYEE ACCT ORIGINAL PAYMENT CURRENT FINAL PFX SEQ CO NUMBER ID NUMBER TYPE COP OBLIG. SUR SCHEDULE BALANCE PYMNT DUE 01 001 50 0809381 10C0UNT050 03 S 473.00 Y 59.13 473.00 03/23/10 01 002 50 0809381 10COUNT050 03 S 473.00 Y 59.13 473.00 03/23/10 01 001 50 0809381 33DCDRG000 09 S 65.00 Y 10.00 65.00 03/23/10 01 001 50 0809381 33DCTRN001 24 D 24.00 Y 10.00 24.00 07/21/10 01 001 36STFLA001 11 O 600.00 Y 50.00 600.00 07/21/10 D_ekfc.tc QA/N.,A-tnca --e-trtry („oit-A OFFICE:JIM_ DATE: SUPERVISOR: DATE: CJIT: DATE: EFTA01625440  EFTA01625441 r0 Ilieer 15-4 Court-Ordered Paym ent Sy stem 4, bate (n-so INPUT FORM *Offender Eiti6 n ) Czy._ FOR 0P021 INITIAL ENTRY OF PAYEE *DC# W35`155 PAYEE PAYEE NAME* TYPE PAYEE ADDRESS* CODE CONTACT PAYEE PERSON/ SUPV DATA ED# IF PHONE INIT ENTRY KNOWN NUMBER INITIAL 33 bru,q DATE Trai s 5- Tr IA.'S r--vsl bcbitioo HP 10 P,s, ti-i, de -4'K 31:scrttAoo 10 0 0 p.g. .CIerK I 0 to volips 10 a r.s. Qty. cltrY... CP D. Fee) I o vwff 05 FOR OM I - OR -:on4 1 OR ;,s -Co•anla 0 PFX* EQ* CNTY CASEit 2 INITIAL ENTRY OF PA ACCT YEE ACCOUNT CODE OR IGI NA L MO NTHLY TYPE* OB FINAL CLAIM# POLICY LIG AT ION PA YM EN T S/DfB/PAYEE PAY DUE ATTENTION CO XxX Mei SCHEDULE DATE ACCOUNT? 3E1 (25 , CAFc-- cl a 1-1 , 34/11c5 so fog. OtreiMS FOR OP22 2 INITIAL EN * Pee. TRY OF SUPERVISION FEE r RATE MONTHLY RATE F DATE P IIMA-EZ kqr O n QS0 / / . COS -• OR OFCR WIT/ SUPV INIT/ ADMI 1 INIT RATE DATA ENTRY Supv Length End Date Reason DATE _...t INIT. T RATE J_ DATE __/__/._ DATE _/_ F DATE _j_j _/___ EM 1 OFCR mart INIT RATE OR SUPV MI T/ DA TA ENTRY , Supv Length End Date Reason DATE ....f INIT. FOR OP24 2 INITIAL EN J_ DATE _J__J___ DA T RATE TRY OF PRC SUBSISTEN TE _J---i— RATE $6.00 CE DAILY RATE F DATE _J I PRC Lcngth=364 Days-OR I. $0.00 END DATE / / OFCR XNIT/ SUPV INIT/ DAT* ENTRY Reason DATE ...J IN' /_.., DATE ___i__ I DA'A e I /  oFICER EFTA01625442 DATE —1 o COURT -O RDERE 2-%-t f D PAY Dcg CHANGE MENT S Y STEM O CD FORM verride P a y me n t U OPOS 4 (S ndisbureadrinte enior Cle mal CV OFFENDE C-ps rk) R C h a n DOD # Sentenc ge Original Obli MomNo m rhyme / ing Auth o gation (1) "SS > PhIt Pm P OPOS 1 (L rity-Ordered/CO r -r Mom& ( L ead Cle S Prepa EM Rats $ Pomo ti rical) y Gomm& n itt, C h a OP22 2 (C nge Cock Pomo&II C4.) Ono./ Pis* I D( idiom+ 4 AT) 61 0 Sf- Tra nsfer Pa dosalm e Soy a i yment Moms O til 0 11 I Ida N Payee to from One Dan d a lk ot $ Meals s (COPS A Another famePP Doeseas I sOblbodo * n$ t ccountin Li'i plop $ 43 • Nurnbte id Am.& g) Soo t om . A Ma ts Mov &Pore mount $ COS Ma 1..21. eltoto MIO dt COMMA im $ W \ Coda MOM &moo A edo Comm% mount Pod Oalo Cods el Now MOIL D Itoto O Older M ita ( .0 °C I I PomoD C 0 Amnon I i .R Phai Su•Mis of kW * Kwon Code Sada C loThiMo Ornow MIS TO: DOC lo PopoP i Supoodo P or NOM PPM/ Cg) Moil Cb dcallnie lklo I Cam w e al emanwa lC ode " ' "to 9 fddoribe Mollida Delete O Olk or kato OPOB 4 (S verride CATMit enior Cle 6 a tupiervis rk) elnill ab Pena Nan Change COPS M o to Oblig 7 angMa Correcti ation le o n OPOS 1(L /Input Error Pampa 0 Ms S ead Cleri COS Rate Soo. cal) Change 0 Amami $ Pomo Non OP22 2 a (CJIT) Cowen Refund/O Code Pomo 10 4 verpaym Ildrallvo (COPS ent to D hymM Ma /MMUS OM. I A c c tg Approva C Payee ono $ I l Reques Soya t) Pomo 0 Nam / of &wit& itordbo &ItoIm not — foam n laded amCod .... . oso s1 .. eevi mm 4. Moody M MUMS Doenam aws Commortre 0bbpdo -OR - es n$ IMO& e t PawNM lam Ato I Ow ms Function I •R Ss MU*Mb PPM Do CarmenC Rams o lt Cc& moo Steanisre In ds elkork Mewl, ado dat e d Silptawb S Comm ith& OM a ias it codo omagrinsta it UM COM ssupoom MIM AM, o.&NM Olapelne ASPS CM & 114 st COMMTM.4/ " teXtballi Socedo tOti ce Mas i COI4 ?meow s.*  Sr Banner - (Custom Easy Wow Inquiry (CWICTYU 3.3.1) (..IISPROD)J Rend Widow Held $elirdibiTers, Desc EPSIE:pc, JEFFREY E a :J Case ID in. • I ••. AIR Sr-100 Cave Filed Citstrn NJrra Jea.R. CF FELONY Case two 'verily Ina/ Dates Waived r Court Type Ow .4 cm Demand Status CLSD CLOSED CASE Deadline 4-)Are2007 PA Lacs I /43atlgs/Events Sent/AFFIFFIF Charge Status AneStrnands I Related Cases Yon we rut rently in CASE SC ear n Rn EFTA01625443  ,Officer's Name: For Month Ending: STATE OF FLORIDA RTME NT OF CORRECTIONS Date/Time submitted: DEPA WRITTEN MONTHLY REPORT YOUIMIE ci 'rein EMPLOYER: fet e DC#: SUPERVISOR'S NANIEVanfaVilliteiC-fe YOUR RESIDENCE ADDRESS: (include Name of EMPLOYER'S ADDRESS: Subdivision, Apartment Complex and Number. Mobile Home Park and Lot Number, if applicable): 2.60 .Aussolot Aie state Weil 334k7) S 61&I lo \slay EMPLOYER'S TELEPHONE N aga F2- Pins°Box) CELLULAR TELEPHONE No. (Provide physical location - OT Post Office PAGER No. EMPLOYER EMAIL: TELEPHONE N YOUR TOTAL MONEY EARNED MONTHLY: CELLULAR TELEPHONE N S /0 K f- (Gross Amount) PAGER No. Full time Part-time Hours Worked Additional (2s ) emplo yment inform ation: Vehicle Make/Model/Year/Tag #: who resided at your residence ring this month: Ligfull names, ages, and your relationship to all ersons 2-t yet "4 R. ,it -. —(o3 — et)V-- Si — VC-0, I 20 SCpp_ YES nave you consumed alcoholic beverages? nces? Have you used or bought illegal drugs or controlled substa ed educa tional, vocati onal classes or menta l Have you attend ent progra ms? health, drug, alcohol, therapy, or self-improvem (If yes, circle which one) enforcement during the last month? Have you been arrested or had any contact with law , attached to report. If yes, explain what happened on separate sheet of paper If you went into debt for any reason, explain: If not working, give reason and source of income: Officer, explain: If you have any questions or problems to discuss with your : If monetary obligation owed, amount paid this month SUBMIT CASH OR PERSONAL CHECKS! Receipts are available through your probation officer. DO NOT Make money order payable to the Department of Corrections. reason and date when payment will be made: If monetary obligation owed and no payment made, give I certify the above to be true and complete- Signature of Officer Offic ei ve Your Signature: Mailing Address: Date WMR Received: City: Date WMR Due: Comments: 5-4 State: Zip: d E-Mail Address: (if applicable) EFTA01625444  Officer's Name: For Month Ending: STATE OF FLORIDA DEPARTMENT OF CORRECTIONS I Date/Time submitted: WRITTEN MONTHLY REPORT YOUR NAME: EMPLOYER: DC#: 14,35"lf r SUPERVISOR'S NAME: -2 .41/'-'. YOUR RESIDENCE ADDRESS: (include Name of EMPLOYER'S ADDRESS: Subdivision, Apartment Complex andNumber, Mobile Home Park and Lot Number, if applicable): /mss"-4. -16 rg - ILA, )3 VI( aegract, Ft 'Worn EMPLOYER'S TELEPHONE No. CELLULAR TELEPHONE No. (Provide physical location —NOT Post Office Box) PAGER No. TELEPHONE No. EMPLOYER EMAIL: YOUR TOTAL MONEY EARNED MONTHLY: CELLULAR TELEPHONE No. $ wi°/ tC (Gross Amount) PAGER No. Full time 4 1 Part-time Hours Worked Vehicle Make/Model/Year/Tag I: Additional (tad) employment information: List full names, ages, and your relationship to all pet-sons who resided at your residence during this month: tan L • 11 - c4• - %& 2- 1- - LT -54la, 4f. re. — Pk/ 2•?' YES lave you consumed alcoholic beverages? 0 Have you used or bought illegal drugs or controlled substances? 0 Have you attended educational, vocational classes or mental health, drug, alcohol, therapy, or self-improvement programs? 0 (If yes, circle which one) Have you been arrested or had any contact with law enforcement during the last month? 6 If yes, explain what happened on separate sheet of paper, attached to report. If you went into debt for any reason, explain: If not working, give reason and source of income: If you have any questions or problems to discuss with your Officer, explain: if monetary obligation owed, amount paid this month: $ Receipts are available through your probation officer. DO NOT SUBMIT CASH OR PERSONAL CHECKS! Make money order payable to the Department of Corrections. If moneta