EFTA00181812¶
Officer’s Name:¶
For Month Ending: ___¶
STATE OF FLORIDA¶
DEPARTMENT OF CORRECTIONS WRITTEN MONTHLY REPORT¶
Date/Time submitted:___¶
Jeffrey Epstein¶
YOUR RESIDENCE ADDRESS: (include Name of Subdivision, Apartment Complex and Number, Mobile Home Park and Lot Number, if applicable):¶
358 El Brillo Way Palm Beach, FL 33480¶
(Provide physical location – NOT Post Office Box)¶
TELEPHONE No. 561-8000¶
CELLULAR TELEPHONE No. 501¶
PAGER No. ___¶
Vehicle Make/Model/Year/Tag #: ___¶
EMPLOYER: FSF¶
SUPERVISOR’S NAME: Darren Indyke¶
EMPLOYER’S ADDRESS:¶
250 S. Australian Ave Suite 1401 West Palm Beach, FL 33401¶
EMPLOYER’S TELEPHONE No.¶
CELLULAR TELEPHONE No.__¶
PAGER No. ___¶
EMPLOYER EMAIL: ___¶
YOUR TOTAL MONEY EARNED MONTHLY:¶
$$ 10K + \text{(Gross Amount)} $$¶
Full time Part-time Hours Worked Additional (2^{nd}) employment information: ___¶
Additional (2^{nd}}) employment information: ___¶
List full names, ages, and your relationship to all persons who resided at your residence during this month:¶
Have you attended educational, vocational classes or mental health, drug, alcohol, therapy, or self-improvement programs?¶
(If yes, circle which one)¶
(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: ___¶
Signature of Officer Received¶
Official Use Only¶
RECEIVED¶
Date WMR Received: JAN 05 2010¶
Date WMR Due:¶
I certify the above to be true and complete:¶
Your Signature:¶
Mailing Address:¶
City: ___¶
State:___ Zip:___¶
E-Mail Address: ___¶
E-Man Address: ___¶
(if applicable)¶