HomeMy WebLinkAboutInv# 061623 - BROWARD SHERIFF'S OFFICE - 06/16/2023Statement Number: 19783
StatementDate: 611612023
Account Number: 00008489 -SP603
Send payment to: Boward Shenffs Office
Attn: Finance / Special Revenue
PO Box 9507
Fort Lauderdale, FL33310
1of 1
Payment Drscount
2601 W Brcward Blvd
Fr. Lauderdale, FL 33312
Dania Beach Community Redevelopment Agen
100 W Dania Beach Blvd.
Dania Beach , FL 33004
Detail Date lnvoice Number Enlry Type Amount Due ltem Aclivity PO Document
4t112023
4t112A23
4t112023
4t1t2023
41112023
41112023
41112023
41212023
41212023
41212023
41212023
412t2023
412t2023
4t2t2023
1680096
16834S7
2054394
2054395
2054396
2118811
2145191
1616246
1680097
2054397
2103830
2105916
2105917
2106634
lnvoice
lnvoice
lnvoice
lnvoice
lnvoice
lnvoice
594.00
594.00
594.00
594.00
594.00
594.00
627.00
486.00
486.00
486.00
513.00
486.00
486.00
486.00
7,620 00
7,620.00
Statement Total 7,620.00
0,30 31 -60 61 -90 Over g0 Total
No. of ltems 0 0 14 0 14
0.00 0.00 7.620.00 0.00 7.620.00
We appreciate your business. lfyou have questions about your account, please call Special Oetail Revenue 954_831_8968
I
I
I
Total for Danra Beach Community R
Total for SP603
106-52-01-552-48-14
1680096
. Employcc CCN
Di
t.t. t\ \t I \P\( l s
Browerd Countv Sheriff's Oflice
f inance-sperial icr enuc Drr isron
P(). Bo\,)50--
l't Laudcrdalc. tlorida -l-l-l l0
INV()t( L - \'Ot ( tll- R
ADI)I o\ \t l\)l l( l sl,RvlcE
: alt L+4
lntohc Nursbcr
Pcrmit Numbcr a20f 3
7. lt
t .t. l\ r t.l sP \( 1:s
1t>*nF b.^,,^:Vl u€ 3"o -5-r
linditg [)atcPariod of Employmenli BeginnrnS Dsle
Ibty Hou.s: Arrived ---Jk2-li--1,-M. Depaned
lehicle RequiEd F(r P.nol Purposcs
<'>2,,l t-!
Dcstinrtron Aa rr
,\Yca- \o
-\-' B€dnning Mileage
Minimum Pcnod {3 Houlsl
Ats.lz-- Min. @,
o{r€ct€d-LrY
3*y q./_
fc\te ('i
Drput)({ \uVchicle Fee
Total ArrorEt Duc
PAYMENT TXJE UPON RECEIPT OF THIS TNVOICE
Signaturc o
STATEMENTS WILL BE ISSUED MONTHLY TO ACCOUNTS
PLEASE MAKEALLCHECKS OR MONEY ORDERS PAYABL
RSTI',RN A PHOTOCOPY OF INVOICE WITH REMII'IAN('E
THAT ARE SET.UP FOR PAYMENT ON A MONTHLY BASIS
E TO: BROWARD COUNTY SIIERIFF'S OFFTCE: Finance-Spcciat Revcar Division.
OR LIST THE I}iVOICE NUMBER(S}ON THE CHECK OR MONEY ORDERS
Do NOT WRITE BELOW THIS LINE
Btorlrli (F-it d or?rer - PRESS DOWN HARD' YOU ARE MAKING 4 COPIES -
SPECIAL DETAIL FILE COPY
/-7a
,. ha,,tt
I
/-/
4
' 6?a)t-! Sqrl
1 683497
FmPl('!(* ( ( \Itro8 t
t't1.1. t\.tl.1. sP.\( Ls
Brou ard Countl SherilT's Officc
frnirnce-Special Rcrcnu.' l)rrrrr,'rr
P( ). Bd\ ')5(ir
cl \**j.o xt( J" :I
lnvorcc Nunt*t
Pffmn Numbar
F .l. r\ .\1.1. sP\( Es
r
oi*io f liv^." S"t^\
fr. Laudcrdalc. Florida .ll.l l0
lNv()l(E-volr(tIER
ADDr ()\.\L P()t l( t: St:RVl( L
Period of F.mployment
Dut-v Hou : Arived
Dalc
t O.'t't,M Depsrred q'
\thicle RcquiEd f(x Palrol Puryo*-s Yes- lu /
?1.
OL
,I e,Ending Date
Exsct Lc&tion Dcstiistion
qtl
Beginning Mileage
Minimum Penqt r, Hoursl
A*d O.,Llt lcl 6
r qte c o(\-t C-li< cl - L lY )
Vchiclc FGc
ToElAmou Duc
o
-u gnaturc of Peminee
PAYMENT DUE UPON RECEIPT OF THIS IN\'OICE
STATEMENTS wlLL BE ISSI.JED MONTHLY TO ACCOUNTS TTIAT ARE SET.UP FOR PAYMENI ON A MONTHLY BASIS
PLEASE MAKEALL CHECKS OR MONEY ORDERS PAYABLE To: BRowARD CoLNTY sHERlf F'S OFFICE: Finaocc-Speciil Rcvcnuc Divk'on'
RETURN A PHOTO('OP\'OF TNVOICE WITH REMITTANCE OR LIST TIIE INVOICE NUMBER(SI oN THE CHECK oR MONEY ORDERS
!
s
SPECIAL DETAIL FILE COPYDO NOT WRITE BELOW THIS LINE
BooR.Pi{rt (R.risd or.re) - PRESS DOWN HARD' YOU ARE MAKING 4 COPIES -
nm N"or" Jrtso" C''L L r. ot3
I I
-,
Broward County Sheriff's Office
Frnance-Special Rer enue I)r!isron
PO. Bor 9507
Ft Lauderdale. L'lorida I lll l0
INVOT( t- . \0r ( l lFR
ADDITIoN,\t, PoI I( I SI RVICT-
Distncr
AI,L
c
\t,\( ]\
Period of Employmenl: Bcgiruting D3le
Dutv Hours: Arriled
2054394
Employce CCN br?lnvoice Numb6
Perm[ Number 62051
J'r )-
T II.L I\ .\LI- SPACESl'ILt. t\
of Addtssot\
*t.t dut 3oo J,2 Jt
o.+l z")o{Or 'z
tl
\o
SignrtuE Of
ft"l
,J)
lo:.] o 4 Depaned Ilrp'*l l(
{
.>^,
h.1 t2
Delitinaoon
l:ndrnr Milcasc
vehiclc Requirtdfo( P.Eol Puposcs
Beginnrn8 Milea8c
Minimum Period ll t{our,}
llh
fc,.tc c orr't (*-YsY 61 dt
\lrn,l
e .{ - 1-rt
\
CCN
Vchiclc Fee
Tolil Amoont Due
, PAYMENT DUE UFON RECETPT OF THIS INVOICE.
I stetsuexm wtLr BE lssuED Mor.{THLy ro Accou
PLEASE MAKE AfL CHECKS OR MONEY ORDERS PAY
s
of Peroitl6
N TS TIIAI ARE SEI',L,I' FOR PA}'MENT ON A MONTHLY BASIS.
ABLI IO: BROWARD COTNTY SHERIrF'S OFFICE: Finance-Sp.cid Revrrr Divirhl
RETURN A PTIOTOCOPY OF INVOICE WITH REMITTANCE OR LIS I TIII] IN\ OI( E NI.]MB[RIS)ON TIIE CHECK OR MONEY
Do NOT WRITE BELOW THIS LINE
llolt,fl. (R6ircd or're) ' PRESS DOWN HARD, YOU ARE MAKING 4 COPIES -
SPECIAL OETAIL FILE COPY
r'
.?A-J
5e {^
/
-t
l<
'&i
lnrplo!.(((\?{4L
E*tatv k*t
Rrovr ard Countl' SherilT's Officc
t n rn.,:-\pc'cill Rcrenue l)rr r.r,,rr
P( ) 8rt\ 950-
I t l..rurlrrr.lilc. t l(,rld..illllr
lN\ot( I \r)t r tlt li
-\l)Dll I( '\ \i I'ril l(I\l R\I(t
2054395
,<ERstr7''./2453P!'tmn Nurnbar
l)isrncr
t lt L t\SP\CES7lel h^0.,,4 ,5*t 3co Na 28 *
Prriod of Employr'ledi BeginninS Datc
y'.r 2-i
Duty Hoursi Anived /o4 7p M.
E$at Localion Hpsr
b78 !'ehicle Rcquir"d for PaEol Purpnscs
ttcginnlng MilcaSe t//
ia-u;:rrr-/rrna{S
FII-I- Ii\ ALL SPACES
Pefminee <-,,- ?3
FnJrr)g l)als
g6r(J-tt,n,--)
\ cs- \,,
/J4
#4 5/'""62#;=yate cr, rtc+e-d - Lill d Sipature Of
Vbhiclc Fec
Total Amount Due
5
$4{1+e-c'
Signatrlrc of Farmio&
PAYMENT DUE UFON RECEIP't OF THIS INVOICE.
I STATEMENTS WILL BE ISSUED MONTHLY TO ACCOUNTS THAT ARE SET.UP FOR PAYMENT ON A MONTHLY BASIS.
PLEASE MAKE ALL CHECKS OR MONEY ORDERS PAYABLE TO: BROWARD COTJNTY SHERIFF'S OFFICE: Fin,icc.SPCCid RCT,GAB DiViSiOO.
RETURN A PTIoT(X'0P\ oF IN\ OI( E U ITI] Rt]]\,IIT'TANCE OR LIST TIIF I\\1)I('E Nt'MI]ER{Si ON THE CHECK OR MONEY ORDER,S.
DO NOT WRITE BELOW THIS LINE
aSORF ir44 (R.vhcd 0lrle)
SPECIAL OETAIL FILE COPY
. PRESS DOWN HARD. YOU ARE MAKING 4 COPIES -
"^Yf i!"*'4
xffiEfulaa
I
eno fft ,CetZMnA
fll.l I\ \1.1. sl,\( t.\
llrorrrrrl ( ourrtr \[tct'ill's ()tlict'
' .it. I
,t ,!:
2054396
Employaa 155 Inroice Numtrer
Pcrmit Numb6 bJo53
DrslnCl
Penod of Employtrt.Dl: Beginning Dslc
Duty Hours: Am\,ID tA M. Dcpan d
.e^.1 'C*QV
5
Be8inniog Milergc
Minimum Period {l Hoursl
rc\t? ( ui r'e t+trl - \.n')
3cr> *re J11JSI *.*n'
FILL IN ALL SPACES
l ndin! I)at.
\l Srn rct l'crl;nttcd
D
\thicle R.quiEd For Perol Puq$ses Yca
-
I n,ling Milce*c
-
t r
r-l -
xo. D t"t,n. ,,5ch9-o i)Ll "-
DVehicle Fcc
Total Arxxrnt Due b4q - 5q{"'
of ((\
Sigrature of PeImitree
PAYMENT DUE UPON RECEIPTOF THIS INVOICE,
STATEMENTS WILL BE ISSUED MONTHLY TO ACCOI.JNTS THAT ARE SET.UP FOR PAYMENT ON A MOI{THLY BASIS
Jeoo cl"
PLEASE MAKEALLCHECKS OR MONEY
RETURN A PHOTOCOPY OT INVOICE WI
DO NOT WRITE BELOW THIS LINE
BSOR? tit4 I Rcarsld l)lr l9l
ORDERS PAYABLE TO: UROWARD COUNTY SHERTFF'S OFFICE: FiMn !-Special Rcvcnuc Dvirion.
TH REMITTANCT OR LIST TH[. INVOICE NIJMBER(S} ON THE CHECK OR MONEY OT,DERS.
. PRESS DOWN HARD. YOU ARE MAKING 4 COPIES -
SPECIAL OETAIL FILE COPY
Pem .(.rn 'h*
O.-|-r3
r -r.i )
!
C
/]n
ll
v 9t
l\amc
lqw+Bron ard 2118811
r"",,r","u, ir / .) ! 3
NAL POLICE SEt
rILL I:{ ALL SPACES
Permitt r No.
\ y-e 1'/ t L'
SigDaturE of P€rminc€
Ft 1.1- I:-.{1"t. sPAcEs
Duty Hours: Arivcd
Be8rnning Datc
lo oo
Exact l,ocation
M
llndrnS
M.S!'ftce
DcstiMtion
Vchiclc I L
(:t Houe l
HIs.- Nlin. r4
rq+{ (or("ecterl - urn
)
Siexlatu e ((\
vehicle Fee
Tohl Amounr Du.
RTCEITT OF THIS INVOICE.
s ,
a -a
BSOR P r4a (tcvi!.d 0l/ l9)
MONTHLY TO ACCO{.'NTS THAT ARE SET.UP FOR PAYMENT ON A MONTHLY BASIS.
OR, MONEY ORDERS PAYABLE TO: BROWARD COtAiTY SHERIFF'S OFFICE: FirEsc.-SFcirl Rcvcnue Divisioo.
\TITII OR LIST THE CHECK OR MONEY ORDERS.
THIS LINE SPECIAL DETAIL
. PRESS DOWN HARD. YOU ARE MAKINC 4 COPIES.
Penod ofEmploymcnt
D*na
3
Bcglnnin8 YilcaSe
2t oo
r.
STATEMENTS WILL BE
' l \\ 'lr\
c' --r 21 451 91
lmflo\cc( ( \,Brow
F
ard
Dr\ i.lon
Fr Florida l3l IL)
)ICE . VOUT'rIER
ADDlTlOliAt. P()l l( t, SERVICT:
FII-L IN AI-L SPACES
P€rmincr
Period of Employmcn!: BegtDnlnS Dale l]'tiling
Dury Houlr: Anivcd
---./-.ltl,
M. Dt?sned \l,t
s Oflice
vchrcle RequiEd For Patrol Purfx)s.'\Yc!- No --.2.-
FIl.t- t\ .u.1. sP.\cEs
((\
Phone No.
B.ginling Milca8e
Minimum Penod (3 Hours)
J i Hr,.
fdk cor{tL €a
L)s -{--](- >-.
./
\1 ?eISign tutr Of
vehiclc Fer
Total Amounl Duc
PAYMENT DUE IJPON RECEIPT OF THIS INVOICE
ID
STAIIMENTS WILL BE ISSUED MONTHLY TO ACCOUNTS THAT ARE SET.UP I{)R P\\'\II\ I
Signaturr
ON A MONTHLY BASIS.
PLEASE MAKEALLCHECKSOR MONEY ORDERS PAYABLE TO: BRoWARD(oUNTY SHERIFF's 0FRCEi Fi.oncc-Spc{ial Revenue Divisio.r.
RETURN A PHOTOCOPY OF II\rr'OlCE WITH REMIfTANCE OR LtST THE IN\IOICE NUMBER(S) ON THE CHECK OR MONEY OR.DERS.
DO NOT WRITE BELOW THIS L[N-E
BSm? H4 lRcvi..d 0l l9r . PRESS DOWN HARD, YOU ARE MAKING 4 COPIES -
SPECIAL DETAIL FILE COPY
t :
.L*IF
i
I
i-q,/)
-
-
EmployccCCN
Print Nffnc
DisEic{
Browardlg.ll5
. VOUC
NAL POLI('T- SE
00 M.
Office Iflroice Numtrl
Permil Number
I
1 61 6246
Hl.l. t\ .\l.t sPA( []s
It'17
CCN
I
F .l. t\ \1.1. sP^(us
Permitt.'r
Pcriod of EndoyEcnt: Bcginning Date
|.
Duty Hours: Arived lA:o
Exrct Loc.tioa
vehicle,
B.gi.nin8 Mileage
-.---
Eodh8 Dstc
Y6- No
-I-
r>
Ll
A \t
+t4
\1rlrr ulri I'rri,,l L I l1,,ur.!
llr.--\lrr),r
Total Amounl Du€
EYN
5
$
DUE UPON RECEIPT OF T}IIS INVOICE.
WILL BE ISSI]ED MONTIILY TO ACCOI.]N IS THAT ARE SET.UP FOR PAYMENT ONA MONTHLY BASIS.
()R\trr\l\ ( )Rl)l Rs P\'\ \lll I TO: BROWARD COUNTT' SHERIFF'S Ol-FICE: FiDance-Specisl Revenuc Divrsion.
ot t\\ ()l( I OR LIST ITIE INVOICE ON THE CHECK OR MONEY ORDERS.
BELOW THIS LINE SPECIAL DETATL FILE @PY
- PRESS DOWN HARD, YOU ARE MAKING 4 COPIES .
T
I
.''J tlo
1
')q
I
ErdilsMrtc.s / il
u.l7
t\
1680097
EmplolceC( \
Prinr Namc 9PrceQ -Tt>-tt (..^
rr{tt
FILI. l\ i\l.l- SPA( t.s
Ct
Pcri(d of Employmont: Bcginning Date
Yrr11o.",lrrita /f .' 11 Au
Brou ard Coun$ Sheriff 's Office
I rn.rn.e-spectalh.cr enue l)rr r'r,,r
PO. Box 950?
Fl. Lauderdale. Florida ll-] l0
lN\'()l( l: - \1)l r( llFR
ADD tO\ \t POI t( r Sl RVICI-
lnrotc NurStr
PerruitNu at 6.1 o51
t'll I t\ .11 l- SP,r.( l:S
4 p€ 3")-Cr
tdFcr r
Dcp{tcd
Ao-r
:CC M. S"niccPerti,nncd fu
,k-tttt-
q/o.,Vchicle R.!!lircd For Patrol Purpo\c\\'.\
-
\o
Beginning Mileage 6
Minnnld P6iod (3 HourE)? *.0
,<te r661 tclerl
-i4:eq,a2-/:--
tiodins Mil(asc /:-t
- LflN i..of
vchrclc Fec
Total Amounl Due S 4/* 4Ka
Sigflalurc ofPcmrrilcc
PAYMElT DUE IJPON RE('EIPT OF TIIIS I\\'oICE
STAIEMTNTS \\'lt t BF ISSI ED \{ONTHLY T0 A(-COLr}{TS TIIAT ARE SET-[ P foR PAYVE,\*T ON A MO\THLY BASIS
PLEASE MAKE ALL ( tlECKS OR VONEY ORDERS PA'I'ABLE TO: BRO!\ARD COI.jNTY SHEUFF'S Of FICE: Finarce-Special Re!eDue Division.
RE-TURN A PHOT(X.oP\ OF INVOI('E U,ITH REMITTANCE OR LIST THE IN\'()I(.I1 NT]MBER(S) ON THE CHECK OR MONEY ORDERS,
DO NOT WRITE BEI,OW THIS LINE SPECIAL OETAIL FILE COPY
Bsf,xp lL+r rRctsd,), r!1 - PRESS DOWN HARD. YOLi ARE MAKING 4 COPIES -
/-7e
a)
*,* {/tt,t,t6"t*
Dara
vehicl€
--L
\4hicl€ Fce
Toul Arnount Due
of THrs lNvotcE.TiPON RECEIPT
WILL BE ISSUED MONTHLY
OR MONEY
TO ACCOUNTS T}IAT SET.UP FOR
. PRESS DOWN HARD. YOU ARE MAKING 4 COPIES
BELOW THIS LINE
Bron ard Countu Sheriff's OfficeI r' 'rric-Spcciolhercouc Drr r'r.,r
PO. Box 9507ll I ruderdale. Florida 13110lN\'()t(h-\ot(l rR
\I)I)I II(,\,\I PoI,I( I \I RvI( L
Joo nl t J '-J s-
R2
FII-L IN AI-L SPACES
l.
't la
2054397
Employce CCN 6t5q
? go,', s
Inroice Numtra
o L
I ll l. I \ .rl.l t .,
e//ot/zlI
I to
Drtv llours: Arrived /o 'rto I \t
Fros r Pa.a,t(-
['l Scnrce PerlorEcda.l .JDestinrlio
Ycs- No r'{ro,1-
Bcgi!'llmt Milc.g€
9i,< rt {3 f-I /MintruaPdrld ll Hounit ,cl *o 6 ur,I', ) 'tdns\
Sitnstur! C ( ('\
Y /)
SPECIAL DETAIL FILE COPY
ltrnr \lmc
Inrf'1(,!rc ( ( \stt Broward Countl Sheriff's Oflicc
I rnance-special her enue Drr r.r,,rr
PO. Bo\')51)7
Ft. Lauderdale. tlorida 3.l l l0
IN\'oI( E. \l(JI.]('HER
ADDII'I0\,\L P()LI( , SERVICI:
Irwoit Nuib6
P.rlth Numb6 6Jc59
FILI- IN ALL SPACES
2103830
t
Drsrncl L
I tLt_ t\
^t_I_
sP \( l:s
Perrniree
Pariod of Employmenli BeSionint Date
Duty Hous: Arived c'o
froil 7",v
b-r((,(L
L
M. DcFrcd M Sen'icc PcribnDad
./z z>
-/,
. '"- 1, r
tteginninE Mileagc
vehicle RequiEd For Patol Purposs Ycs- No
\1:HT:::*E 6K
ra,fe corr-t cl<J SiSnaturc (rl ((\
Vchiclc Fec
Tol.l Anbunt Dtrc W' 5lt;.ou
s
s
igratue of Parmilter
PAYMENT DUE UPON RECEIPT OF THIS INVOICE.
STAIIMENTS WILL BE ISSUED MONTHLY TO ACCOU'}.ITS T1IAT ARE SET.UP FOR PAYMENT ON A MONTHLY BASIS.
ILEASE MAI(E ALL CHECKS OR MONEY ORDERS PAYABLE TO: BROWARD COUNTY SHERTFF'S OFFICE: Finrn@-Spccial Rcvcnuc Divisim.
RETURN A PHOTft'OPY OF INVOICE \I ITH REMITTAN('E OR LIST TIIE INVOICE NUMBERIS) oN THE CHECK OR MONEY ORDERS,
DO NOT WRITE BELOW THIS T I\T
BSORP 4+r iR.!r*d0t lir - PRESS DOWN HARD. YOU ARE MAKING .I I'oPIES -
SPECIAL OETAIL FILE COPY
(.a
Za's+
'14
Ph
{
(_.*
&,fiF--
,Ny',
u/4
I
2105916Broward Countr Sheriff's 0flice
lrrnilnce-Sp€cial I r\ enur' Dtr tiron
PO. Box 9507
rr t aude.dalc. Florida ll i l()
tNvot( 1" - \'0UC't{}.R
ADDITIONAL POLICE SERVICE
lnvoicc Nunh.l 6tv
,c
i ni"ot.t EJ s(I
FILL I\ ALL SPACES
Permitlet (il o{ a A",L
FILI, I\ At,I, SPACES
',1 J$
Pcnod of Employm!'nt: tlcgrnninB Datc ut)3
0oA N,t.ur ilDuty
1,.
ri. I
Pcriod (3 Hour.)
utl !oo tbr t)
u \thicle RequirEd F(x P.rrol Purpos.li
EndihS Milcagc.'+#6'1.
Yca- No
I"/z
Hnt.
fCrte corrt tfezt- u0 SigtlaN,t Of
'"r)s ,lkb
PAYMENT DTIE L:RfN RECEIPT OF TIIIS INVOICF,
STATEMENTS WILL BI ISSUED MONT}ILY TO AC('OUNTS TI IAT ARI S['t.tjP FOR PAYMENT ON A MONTTILY BASIS,
pLEASF MAKE ALL ( lll:( KS OR MONt:\'ORDERS PAYABL I: TO: BROWhRD ( OL NTl'SItFRIFF S OFFICE: Financ(-Special Rclenue Division
RETURN A PHOTOCOP\' ot l\1'OICE \r'lTH REMITTANC[ ( )R LIST T]lt, lN\()lC[ \U]lBERlS) ON rHE CHECK oR MONIY ORDERS.
DO NOTWR|TE BEL()u IHIS LtNl SPECIAL DETAIL FILE COPY
BsoRP r:r-r rlctbrd i)r rer - PRESS D0\\ N I{ARD. \'()ti ARt: MAKING 4 COPIES -
Erhployee CCN
)
IL
t\,
tb
7L
2
Empl()\tt ( ( \l55uu
(-)r\,P
., .)
Bron erd Coun$ Sheriff's Office. I inance-Speciallcr enuc Dr r r.ron. \. { | .- P( t. Box 9507
Ft. Lauderdale. Florida .13.i llJ
lN\'()t( tr - \'(]t ( HER
ADDIItO\.\t_ POI.l( t: SI.RVI( 1.
21 0591 7lnvoEc Number
Permn \unber
\.n, c4
ltl.t. t\.\t.t. \P\( l:s
C
Pcriod of Enploymcnt: Bcginning Dare rt -o
Ihty Hours rb a.M. txpstd
(9+ Pa.o \c
rk* 3oo ,..re cnd ql [- t. I\ \t.t. \P\( []s
al
M. scnrca
t-v
e
n fuo}VchrlJlc RequiEd flx hlrol Puposes
Frdinq Milcsut
-
Yes- No
:...-4":r'uy4|t <orrt tttr\
'- 5,t (}-r
\lr!1 ,?&s r55-Lfi1 of
Vchi.le Fe.
Tot l Alnounr Dua 5.3i { Yto.*
S o
PAYMENT DUE UPON RECEIPT O[ TIIIS IN\'OI('I:,
STATEMEI{TS WILL BE ISSUED II(}I'(TtIL\ T0 A('('OUNTS THAT ARE SET.UP FOR PAYVENT ON A MONTHLY BASIS.
PLEASE MAKE ALL CHECKS oR MO\t:\'oRDERS PAYABLE TO: BRO\IARDCOUNTY SHERIFF'S OFFICE: Financc-Speci.l Revcnuc Divisioo.
X.ETURN A PHOTOCOPY OF lN\OlCt, wlTll REMITTANCE OR LIST Tllt lNvol( E NUMBER(S) ON IHE CHECK OR MONEY ORDERS.
SPEC'AL DETAIL FILE COPYDO N()l \l'RITt: UF.1-o\\ IHls LINI,
il\()RI' 'r.r lRr\rrcJ rrl l9r . PRESS DO\IN HARD. YOU ARE MAKTNG 4 COPIES -
_.t
loa*=
f {
c(-li
trnpk)\.(. ( ( \?<tz
K6e*€v-
21 06634
t,.
Rrorr ard Countl Sheriff 's Office
l rr rnie-Sptcial Rcrenur' t)rr .L, l
P() llor (]il)-
iI [.Jud('rd.lc. l]l(,nih lljl(l
I\\ ()l( I - \'(ll t lll R.\l)l)l Ilo\ \l P( )l l(I\t R\l(t.
lDvdt N@t r
Pcrn Nunb.,fuifr* ktt,
\1,\( t\
lcrs u; .: r. ia*t.*
Cz-53
H1.t. l\ \l.t.
P6iod of Employment: B€ginninS Dare 4-z-z )
Dlty Houls: Amv!'d /2t
t t. t\ \t.1. sPl( ]ts
(-z-?lltlln! I)rrc
M. DcA.rted 7rt \l Se^ r.c Pc.lirmed a,
c (c Br?itt s.S
fno
Fiorr Pte<A,rri c 5ra
Cre"/C khicle Requittd Fq ?atrol Purpo6cs
iA
-#€ 5"/'""5+44
Y6- No -:-AABrginning Milcage
o tr/zeJ - r-m
vdrklc F..
Tod Anrourrl Dr.
/oi (1\
s
s
,41+? 1Vtr!
ol'
PAYME\] I)L I L'Po\ RECEIPT OF TIIIS I\\ 0I( I:
STATEMENTS \\1LL BE ISSL;ED MONTIILY T0 A('(1)U\TS TIIAI'ARE STT.I]P ToR PAYME\T ON A MONTHLY BASIS
PLEASE MAKE ALL ( llECKS OR VON E'\ ( )RDt:RS PA\ ABLt- T0 BRO\rA R D ( Ol \T't' StIERIFF S OFFICE: Finance-SFcial Revenue Division.
RETURN A PHOTO( OPY Of lNvOlCh \\ lTtl RIVITTAN( E OR LIST TI{t I\\ Olt F NUI\IBER(S) ON THE CHECK OR I\|ONEY ORDERS.
DO NOT \I'RITE BELO\T'THIS LINL SPECIAL DETAIL FILE COPY
i BsoRP !$ { R.\,sed rr.r rer PR}ISS DOWN IIARD. \'OL ARE MAKING 4 COPIES -
I
I