09/21/09
OPSB003-XX


OFFENDER COP OBLIGATIONS
CHANGE ORDER



TIME: 16:34:23
PAGE: 1


OFFICER NUMBER: 07824

OFFICER NAME: SLOANE, CARMEN

DOC NO:

NAME: EPSTEIN, JEFFREY



STATUS: ACTIVE P/P



<table><thead><tr><th>PFX</th><th>ACCT SEQ</th><th>CO</th><th>CASE NUMBER</th><th>PAYEE ID NUMBER</th><th>ACCT TYPE</th><th>ORIGINAL COP OBLIG.</th><th>SUR</th><th>PAYMENT SCHEDULE</th><th>CURRENT BALANCE</th><th>FINAL PYMNT DUE</th></tr></thead><tbody><tr><td>01</td><td>001</td><td>50</td><td>0809381</td><td>10COUNT050</td><td>03 C</td><td>473.00</td><td>Y</td><td>0.00</td><td>0.00</td><td>03/23/10</td></tr><tr><td>01</td><td>001</td><td>50</td><td>0809381</td><td>33DCDRG000</td><td>09 9</td><td>65.00</td><td>Y</td><td>10.00</td><td>65.00</td><td>03/23/10</td></tr><tr><td>01</td><td>001</td><td>50</td><td>0809381</td><td>33DCTRN001</td><td>24 C</td><td>24.00</td><td>Y</td><td>0.00</td><td>0.00</td><td>07/21/10</td></tr><tr><td>01</td><td>001</td><td></td><td></td><td>36STFLA001</td><td>11 O</td><td>600.00</td><td>Y</td><td>54.55</td><td>485.54</td><td>07/21/10</td></tr></tbody></table>





DATE: 9-23-09

SUPERVISOR: WA DATE: 9/22/09

CJIT: DATE: 10/13/09

EFTA00181807



AS OF: 08/07/09

OPS0112-02



FLORIDA DEPARTMENT OF CORRECTIONS

COURT ORDERED PAYMENTS

TIME: 15:23:16

OFFICE: LAKE WORTH

OFFENDER FINANCIAL OBLIGATION AGREEMENT

VERIFICATION DOCUMENT

OFFENDER: EPSTEIN, JEFFREY

OFFICER: SLOANE, CARMEN

PAGE:

DOC NO:

SUPERVISION BEGIN DATE: 07/22/09 SCHED TERM DATE: 07/21/10

<table><thead><tr><th></th><th></th><th>FINAL PAYMENT DUE DATE:</th><th>03/23/10</th><th>% PAID</th><th>0%</th></tr></thead><tbody><tr><td>PAYEE: DEPARTMENT OF CORRECTIONS DRUG TESTING</td><td></td><td>ORIGINAL AMOUNT OWED:</td><td>$65.00</td><td>% SUPERVISION REMAINING:</td><td>92%</td></tr><tr><td>PAYEE ID: 33DCDRG000</td><td></td><td>NET CHANGE:</td><td>$0.00DB</td><td>PAYMENT SCHEdule:</td><td>$10.00</td></tr><tr><td>PREFIX: 01</td><td></td><td>TOTAL OBLIGATION:</td><td>$65.00DB</td><td>AVERAGE PAYMENT</td><td>$0.00</td></tr><tr><td>ACCT SEQ:</td><td></td><td>PAID TO DATE:</td><td>$0.00</td><td>LAST PAYMENT DATE:</td><td>00/00/00</td></tr><tr><td>CASE NO: UNIF CS#:</td><td></td><td>BALANCE</td><td>$65.00DB</td><td>SURCHARGE</td><td>¥</td></tr><tr><td>STATUS: SUSPENDED</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>PAYEE: DC OFFICER TRAINING/EQUIPMENT SURCHARGE</td><td></td><td>FINAL PAYMENT DUE DATE:</td><td>07/21/10</td><td>% PAID</td><td>0%</td></tr><tr><td>PAYEE ID: 33DCTRN001</td><td></td><td>ORIGINAL AMOUNT OWED:</td><td>$24.00</td><td>% SUPERVISION REMAINING:</td><td>92%</td></tr><tr><td>PREFIX: 01</td><td></td><td>NET CHANGE:</td><td>$0.00DB</td><td>PAYMENT SCHEdule:</td><td>$10.00</td></tr><tr><td>ACT SEQ: 001</td><td></td><td>TOTAL OBLIGATION:</td><td>$24.00DB</td><td>AVERAGE PAYMENT</td><td>$0.00</td></tr><tr><td>SE NO: 0809381 UNIF CS#:</td><td></td><td>PAID TO DATE:</td><td>$0.00</td><td>LAST PAYMENT DATE:</td><td>00/00/00</td></tr><tr><td>ATUS: DEFERRED</td><td></td><td>BALANCE</td><td>$24.00DB</td><td>SURCHARGE</td><td>¥</td></tr><tr><td>PAYEE: STATE OF FLORIDA COST OF OPEN</td><td></td><td>FINAL PAYMENT DUE DATE:</td><td>07/21/10</td><td>% PAID</td><td>0%</td></tr><tr><td>PAYEE ID: 36STFLA001</td><td></td><td>ORIGINAL AMOUNT OWED:</td><td>$600.00</td><td>% SUPERVISION REMAINING:</td><td>92%</td></tr><tr><td>PREFIX: 01</td><td></td><td>NET CHANGE:</td><td>$0.00DB</td><td>PAYMENT SCHEdule:</td><td>$54.55</td></tr><tr><td>ACCT SEQ: 001</td><td></td><td>TOTAL OBLIGATION:</td><td>$600.00DB</td><td>AVERAGE PAYMENT</td><td>$0.00</td></tr><tr><td>CASE NO:</td><td></td><td>TO DATE:</td><td>$0.00</td><td>LAST PAYMENT DATE:</td><td>00/00/00</td></tr><tr><td>STATUS: OPEN</td><td></td><td></td><td>$600.00DB</td><td>SURCHARGE</td><td>¥</td></tr></tbody></table>

<table><tr><td>SURCHARGE DUE:</td><td>$2.98</td></tr><tr><td>PAYMENTS DUE:</td><td>$74.55</td></tr></table>

REQUIRED PAYMENT: $77.53

RIFIED BY OFFICER: DATE: 8-11-09

I UNDERSTAND MY SPECIAL CONDITION(S) TO FULFILL THIS FINANCIAL OBLIGATION(S) PRIOR TO MY SCHEDULED SUPERVISION TERMINATION DATE(S) AS ORDERED BY THE SENTENCING AUTHORITY, AND ACKNOWLEDGE RECEIPT OF A COPY OF THIS FINANCIAL OBLIGATION AGREEMENT.

FAILURE TO PAY COULD RESULT IN VIOLATION OF SUPERVISION.

OFFENDER:

DATE: 8-11-09