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EFTA01625438 | EFTA01625446 Mficer's Name: For Month Ending: Date/Time submitted: STATE OF. FLORIDA DEPARTMENT OF CORRECTIONS WRITTEN MONTHLY REPORT tetn g; youRtum &5-t Dat:IN YOUR RESIDENCE ADDRESS: (Include Name of Subdivision, Apartment Complex and Number, r, if applicable): &ghat@ Lot M ile tiortifel ~yII FL EMPLOYER:F5Fnlw SUPERVISOR S NAME: EMPLOYER'S ADDRESS: 250 5•AuStratiCth hie . Gee ILKA Writ- \cairn ?math trt EMPLOYER'S TELEPHONE No. (Provide physical location —)Post Office Box) TELEPHONE N CELLULAR TELEPHONE No PAGER No. CELLULAR TELEPHONE No. PAGER No. EMPLOYER EMAIL: YOUR TOTAL MONEY EARNED MONTHLY: (Gross Amount) $ "1"/*/ tvFull timej,_ Part-time Hours Worked minimal (t!) employment information: Vehicle Make/Model/Year/Tag II: List full names, a es, and your relationship to all persons who resided at your residence during this a — GC Z G- — P4A4 22 SI*" — 31 month: lave you consumed alcoholic beverages? Have you used or bought illegal drugs or controlled substances? Have you attended educational, vocational classes or mental health, drug, alcohol, therapy, or self-improvement programs? (U yes, circle which one) Have you been arrested or had any contact with law enforcement during the lad month? If yes, explain what happened on separate sheet of paper, attached to report. If you went into debt for any reason, explain: /v.77: Lt, ., YES NO 0' G O 21 O 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 Correction. If monetary obligation owed and no payment made, give reason and date when payment will be made: I , I certify the above to be true and comple Official Use Only: Signature of Officer Receiving Report: Date WMR Received: Date WMR Due: Comments: Your Signature: Mailing Address: lif er to lL City: P P State: ft Zip: 93 tn. E-Mail Address: (if applicable) EFTA01625446
March 3, 2026 at 6:34 PM