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EFTA00181807 | EFTA00181813 STATE OF FLORIDA NT OF CORRECTIONS RTME DEPA ,Officer's Name: For Month Ending: Date/Time submitted: WRITTEN MONTHLY REPORT n YO DC# YOUR RESIDENCE ADDRESS: (include Name of Subdivision, Apartment Complex and Number. Mobile Home Park and Lot Number, ifapplicable): S 61 &Ito Way 32/4160 alai a ga a (n F2- NOT Post Office Box) (Provide physical locatio TELEPHONE No CELLULAR TELEPHONE N PAGER No. e EMPLOYER: fet SUPERVISOR'S NANIEVanfaVI-LaC-fe EMPLOYER'S ADDRESS: Stat PIN 2-t 334d it Wrat tails geocin i s a EMPLOYER'S TELEPHONE N CELLULAR TELEPHONE No. PAGER No. EMPLOYER EMAIL: YOUR TOTAL MONEY EARNED MONTHLY: (Gross Amount) $ /0 K fHours Worked Part-time Full time ation: inform yment Additional (2s ) emplo Vehicle Make/Model/Year/Tag #: s who resided at your residence during this month: Llsjfull names, ages, and your relationship to all person R. -ah• 7 el n r4 2:‘ VC,- scroPoL42. EA — &AC* Ur srpp_ VI) YES nave you consumed alcoholic beverages? nces? Have you used or bought illegal drugs or controlled substa l menta or classes onal vocati tional, educa ed Have you attend ms? progra ent 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 0 : 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 Correction reason and date when payment will be made: If monetary obligation owed and no payment made, give Offic Signature of Officer ei ve I certify the above to be true and completeYour Signature: Mailing Address: Date WMR Received: Date WMR Due: Comments: City: 5-4 State: Zip: E-Mail Address: (if applicable) EFTA00181813
April 23, 2026 at 5:18 PM