Case 9:08-cv-80119-KAM Document 547-1

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 • YOUR % DC#: YOUR RESIDENCE ADDRESS: (include Name of Subdivision, Apartment Complex and Number. Mobile Home Park and to: Number. if applicable): Case 9 08-cv-80119-KAM Document 547-1 Entered on FLSD Docket 05/17/2010 Page 2 of 4 Dfficer's Name: STATE OF FLORIDA For Month Ending: DEPARTMENT OF CORRECTIONS I Date/Time submitted: WRITTEN MONTHLY REPOR1 EMPLOYER: t -61 : SUPERVISOR'S NAmEV:arravt Zia Vein S bl llo \ta n° afro ?to • ( FL (Provide physical location — NOT Post Office Box) TELEPHONE N CELLULAR TELEPHONE N PAGER No. Vehicle Make/ModeVYear/Tag #: EMPLOYER'S TELEPHONE No CELLULAR TELEPHONE No. PAGER No. EMPLOYER EMAIL: YOUR TOTAL MONEY EARNED MONTHLY: 10 K 4- (Gross Amoutu) Full dmeY__ Part-time Hours Worked Additional (2s ) employment informadow names, ageskand your r shiv ... . o all nersons who resided at your residence yhte inentiv 7,,ir 5111. 2O YES ave 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? (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: o tsr 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 Date WMR Received: Date WMR Due: Comments: IA e v E I certify the above to be true and complete. Your Signature: Mailing Address: City: State: Zip: E-Mail Address: atapplicabk) CtiD -144 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: • 94: YOUR NAME: 4, WRITTEN MONTHLY REPORT EMPLOYER: F(P DC#: wsnir _ - SUPERVISOR'S NAME: r ib -1/,•-' EMPLOYER'S ADDRF-SS. YOUR RESIDENCE ADDRESS: (include Name of Subdivision. Apartment Complex and Number. Mobile Home Park and to; Number, if applicable): ' N CR tt„ Onih s..te-c, pogrom (Provide physical location — TELEPHONE No. CELLULAR TELEPHONE No.. PAGER No. Vehicle Make/Model/Year/Tag #: )341 EMPLOYER'S TELEPHONE No. CELLULAR TELEPHONE No PAGER No. ----- EMPLOYER EMAIL: YOUR TOTAL MONEY EARNED MONTHLY: $ .0.10 tC (Gross Amount) 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, Save 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? (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: YES 8 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. 1 (1 Official Use Only: Signature of Officer Receiving Report: If monetary obligation owed and no payment made, give reason and date when payment will be made. ate WMR Received: Date WMR Due: Comments: C \ I certify the above to nd Your Signature: MailingnAddress: Y City: Vote. 66-4‘. State: Zip: 3).1 t E-Mail Address: ere...240Cris (if applicable) EFTA00726491 Case 9:08-cv-80119-KAM Document 547-1 Entered on FLSD Docket 05/17/2010 Pa ifficer's Name: For Month Ending: Date/Time submitted: t STATE OF FLORIDA DEPARTMENT OF CORRECTIONS WRITTEN MONTHLY REPORT YOl isiNflt tern EMPLOYER:F5F Dat: SUPERVISOR'S NAME: 0 -1-b•-iiCt-7 YOUR RESIDENCE ADDRESS: (include Name of Subdivision, Apartment Complex and Number, EMPLOYER'S ADDRESS: Mt ectorne Par,* apd LotAimber, if applicable): f- iorilICIIN lrn 'ev ch FL (Provide physical location - NOT Post Office Box) TELEPHONE No. CELLULAR TELEPHONE N PAGER No. Vehicle Make/Model/Year/Tag #: Werul- <Olin Ovckyt 3347 EMPLOYER'S TELEPHONE No. CELLULAR TELEPHONE No. PAGER No. EMPLOYER EMAIL - YOUR TOTAL MONEY EARNED MONTHLY: tO/ •%- (Gross Amount) Full time N. Part-time Hours Worked Additional (2ad) employment information: sk i List full names, net and v ur relationship to all peso resided at your resid ng this month: leave 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? (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: YES NO 0' EF B ry 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. I t , Official Use Only: Signature of Officer Receiving Report: If monetary obligation owed and no payment made, give reason and date when payment will be made: ate WMR Received: Date WMR Due: Comments: I certify the above to be true and complete: Your Signature: Mailing Address: City: r State: Ft. E-Mail Address: (if applicable) zip: 931S1- EFTA00726492