EFTA00726489.pdf

Case 9:08-cv-80119-KAM Document 547-1 Entered on FLSD Docket 05/17/2010 Page 1 of 4 CASE NO: 08-CV-80119-MARRA/JOHNSON Notice of Supplemental Authority on Plaintiff Jane Doe's Motion for an Order to Show Cause and for an Order to Compel and Incorporated Memorandum of Law (DE 138) EXHIBIT A EFTA00726489  Case 9 08-cv-80119-KAM Document 547-1 Entered on FLSD Docket 05/17/2010 Page 2 of 4 Dfficer's Name: For Month Ending: STATE OF FLORIDA DEPARTMENT OF CORRECTIONS I Date/Time submitted: WRITTEN MONTHLY REPOR1 • YOUR % Vein EMPLOYER: t -6 1 : DC#: YOUR RESIDENCE ADDRESS: (include Name of SUPERVISOR'S NAmEV:arravt Zia Subdivision, Apartment Complex and Number. Mobile Home Park and to: Number. if applicable): S bl llo \ta n° EMPLOYER'S TELEPHONE No afro ?to • ( FL CELLULAR TELEPHONE No. (Provide physical location — NOT Post Office Box) PAGER No. TELEPHONE N EMPLOYER EMAIL: YOUR TOTAL MONEY EARNED MONTHLY: CELLULAR TELEPHONE N 10 K 4- (Gross Amoutu) PAGER No. Full dmeY__ Part-time Hours Worked Vehicle Make/ModeVYear/Tag #: Additional (2s ) employment informadow 1. 511 names, ageskand your r shiv 7,,ir . ...o all nersons who resided at your residence yhte inentiv 2O YES ave you consumed alcoholic beverages? Have you used or bought illegal drugs or controlled substances? o Have you attended educational, vocational classes or mental health, drug, alcohol, therapy, or self-improvement programs? (If yes, circle which one) tsr Have you been arrested or had any contact with law enforcement during the last month? 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 monetary obligation owed and no payment made, give reason and date when payment will be made: Signature of Officer R e vE I certify the above to be true and complete. Your Signature: Mailing Address: Date WMR Received: IA City: CtiD -144 Date WMR Due: Comments: State: Zip: E-Mail Address: atapplicabk) EFTA00726490  Case 9 08-cv-80119-KAM Document 547-1 Entered on FLSD Docket 05/17/2010 Page 3 of 4 Officer's Name: STATE OF FLORIDA For Month Ending: DEPARTMENT OF CORRECTIONS I Daterflme submitted: WRITTEN MONTHLY REPORT • 94: YOUR NAME: 4, EMPLOYER: F (P DC#: wsnir SUPERVISOR'S NAME: r _, - i b -1/ •-' YOUR RESIDENCE ADDRESS: (include Name of Subdivision. Apartment Complex and Number. EMPLOYER'S ADDRF-SS. Mobile Home Park and to; Number, if applicable): ' N CR tt„ Onih )341 s..te-c, pogrom EMPLOYER'S TELEPHONE No. (Provide physical location — CELLULAR TELEPHONE No PAGER No. ----- TELEPHONE No. EMPLOYER EMAIL: CELLULAR TELEPHONE No.. YOUR TOTAL MONEY EARNED MONTHLY: $ .0.10 tC (Gross Amount) PAGER No. Vehicle Make/Model/Year/Tag #: Full time 4. Part-time Hours Worked Additional (r d) employment information: List full names, ages, and your ggigiionship t rsons who resided at Your regidenCe during this Viva! - L.r" -)/03 11:11. -- ice, S ave you consumed alcoholic beverages? YES Have you used or bought illegal drugs or controlled substances? Have you attended educational, vocational classes or mental 8 health, drug, alcohol, therapy, or self-improvement programs? (If yes, circle which one) Have you been arrested or had any contact with law enforcement during the last month? 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 monetary obligation owed and no payment made, give reason and date when payment will be made. 1 Official Use Only: I certify the above to nd (1 Signature of Officer Receiving Report: C Your Signature: ate WMR Received: MailingnAddress: Y Date WMR Due: City: Vote. 66-4‘. Comments: State: Zip: 3).1 t E-Mail Address: ere...240Cris (ifapplicable) \ EFTA00726491  Case 9:08-cv-80119-KAM Document 547-1 Entered on FLSD Docket 05/17/2010 Pa ifficer's Name: For Month Ending: STATE OF FLORIDA DEPARTMENT OF CORRECTIONS Date/Time submitted: WRITTEN MONTHLY REPORT t YOl isiNflt tern EMPLOYER:F5F Dat: SUPERVISOR'S NAME: 0 -1-b•-iiCt-7 YOUR RESIDENCE ADDRESS: (include Name of EMPLOYER'S ADDRESS: Subdivision, Apartment Complex and Number, ectorne Par,* apd LotAimber, if applicable): Mt f- lrn 'ev ch FL iorilICIIN (Provide physical location - NOT Post Office Box) Werul- <Olin Ovckyt 3347 EMPLOYER'S TELEPHONE No. CELLULAR TELEPHONE No. PAGER No. TELEPHONE No. EMPLOYER EMAIL- YOUR TOTAL MONEY EARNED MONTHLY: CELLULAR TELEPHONE N tO/ •%- (Gross Amount) PAGER No. Full time N. Part-time Hours Worked Vehicle Make/Model/Year/Tag #: Additional (2ad) employment information: List full names, net and v ur relationship to all peso resided at your resid i ng this month: sk le ave you consumed alcoholic beverages? Have you used or bought illegal drugs or controlled substances? YES NO 0' EF Have you attended educational, vocational classes or mental health, drug, alcohol, therapy, or self-improvement programs? B (If yes, circle which one) Have you been arrested or had any contact with law enforcement during the last month? ry 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: S Receipts are available through your probation officer. DO NOT SUBMIT CASH OR PERSONAL CHECKS! Make money order payable to the Department of Corrections. If monetary obligation owed and no payment made, give reason and date when payment will be made: I certify the above to be true and complete: I , Official Use Only: t Signature of Officer Receiving Report: Your Signature: Mailing Address: ate WMR Received: Date WMR Due: City: r Comments: State: Ft. zip: 931S1- E-Mail Address: (if applicable) EFTA00726492