EFTA00181813 # STATE OF FLORIDA DEPARTMENT OF CORRECTIONS WRITTEN MONTHLY REPORT Officer’s Name: ___ For Month Ending: ___ Date/Time submitted:___ YOUR NAME DC# YOUR RESIDENCE ADDRESS: (include Name of Subdivision, Apartment Complex and Number. Palm Beach FLORIDA (Provide physical location – NOT Post Office Box) TELEPHONE No. 561 CELLULAR TELEPHONE No. 12(-1 PAGER No. ___ Vehicle Make/Model/Year/Tag #: ___ EMPLOYER: ___ FQF SUPERVISOR'S NAME: EMPLOYER'S ADDRESS 201 A15-1 A2 Palm Bush 334×0 EMPLOYER'S TELEPHONE No. CELLULAR TELEPHONE No.__
PAGER No.
EMPLOYER EMAIL:
YOUR TOTAL MONEY EARNED MONTHLY: $$ \textcircled{10}, 12 $$(Gross Amount) Full time Part-time Hours Worked Additional (2^{nd}} employment information: ___ ## List full names, ages, and your relationship to all persons who resided at your residence during this month: | | YES | NO | | :--- | :---: | :---: | | Have 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: | ___ | ___ | | 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: ___
Official Use Only: Signature of Officer Receiving Report:
Date WMR Received:___
Date WMR Due:___
Comments:
I certify the above to be true and complete: Your Signature: ___ Mailing Address: 20 Y CE BALL. City: John Ben F. State: EC Zip: 3748 E-Mail Address: [email_address] (if applicable) EFTA00181814 Officer's Name: # STATE OF FLORIDA DEPARTMENT OF CORRECTIONS WRITTEN MONTHLY REPORT For Month Ending: 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 CELLULAR TE PAGER No. ___ Vehicle Make/Model/Year/Tag #: ___ EMPLOYER: FSF SUPERVISOR'S NAME: ___ EMPLOYER'S ADDRESS: 250 S. Australian Ave. Suite 1404 West Palm Beach, FL 33401 EMPLOYER'S TELEPHONE No. CELLULAR TELEPHONE No.__ PAGER No. ___ EMPLOYER EMAIL: ___ YOUR TOTAL MONEY EARNED MONTHLY: $$ +10, \dots $ (Gross Amount) Full time Part-time Hours Worked Additional $ 2^{\mathrm{nd}} $ employment information: ___ ## List full names, ages, and your relationship to all persons who resided at your residence during this month: SA - 31 Frank, ZG - Fred 22, 5.LB-65, DL. Leigh 50 Have 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) If yes, explain what happened on separate sheet of paper, attached to report. (If yes, circle which one) Have you been arrested or had any contact with law enforcement during the last month? $ \Box $ 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: ___ Official Use Only: Signature of Officer Receiving Report: Date WMR Received: ___ Date WMR Due: ___ 3|1|10 I certify the above to be true and complete: Your Signature: Mailing Address: 5358 B-111 City: PP State: FL Zip: 33452. E-Mail Address: ___ (if applicable)