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*** REQUESTOR: EBI9162 - BIRCHER, ELISA PO-FORT WORTH DPO II **.

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*** s Y S M E FOR M P R I N T
MESSAGE 10: 949901 DATE: 08/03/11 TIME: 08:59am PRIORITY: 000
SUBJECT: MONTHLY RESTITUTION PAYMENT
INITIAL: UPDATE:
OFfENDER REPORTED TO THE CLERK OF THE COURT Of CONVICTION FOR PAYMENT
OF FINES,FEES,& COURT COSTS. DATE VERIFIED: / 1
NAME : \,\\, Y\\ \
DATE OF RELEASE: 1 a /\\ .

DISCHARGE DATE: J 1 /\3
TOTAL AMOUNT IMPOSED: cD .
BALANCE AS OF TODAY 1 S DATE: 'l, / 1\\
TOTAL MONTHLY EXPENDITURES
NtT MONTHLY INCOME: $
$" &0.,00 -m
CAR PAYMENT: $
- -
$ O:O .. TD
INSURANCE: $ 'S\Q .ro
LIST LUXURY ITEMS
UTILITIES: $
.oD
ITEM: COST:
PHONE: $

1. $
LOANS: $
"lw'oo
2. $
FOOD: $
VCO D'O
3. $
C:LOTHING: $ 4. $
LUXURY-NaN-ESSENTIALS TOTALS $
$
CHILD SUPPORT/ALIMONY$
-
.-
ITEMIZE OTHER EXPENDITURES
OTHER (ITEMIZE)
TOTAL EXPENSES $
TOTAL LESS EXPENSES $
S'UBMITTED BY/DPO:
APPROVED BY/OPO:
OFfENDER IS DIRECTED
RESTITUTION IS
AS SOON AS POSSIBLE.
01ST: OFfICER
SUPERVISOR
PSV-71(12/01/0B)
$ ITEM COST
4<tcG.lX)
1. $
. OD
2. $
3. $
4. $
5. $
TOTALS $
TO PAY THE FOLLOWING AMOUNT EVERY MONTH
PAID IN FULL,WHICH SHOULD BE ACCOMPLISHED
$ co '-to Ot}
qjlp/II
",J/ '1(-
1/3/11
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