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HomeMy WebLinkAboutInv# ACID5984 - GEORGE J. MICHALEK - 05/05/2023ilo SROWARD SHtRlFFs fIRE T,tsct,t 2601 l,V. EROWARD SLVD FORT LAUDERDALE. fL ]33I2 For Ouestions Contact the refund departmont Rofu nds@DEil6chcorhpul€r com Explanation of Refirnrl SeMc€ Date Claim Ref* Palrent Mrchalek,George O6t3Ot2022 II.A/OICE DCBSO9742 PAID INPolicy lD# ACID ACID,5984 Retund Amo'rnt -250 0O lssue Check Payable to: Payea G€orge J Michalek Rospdsble pdt pe'd *ld [Er.i.€ paxl Rosgo.reu. pdv p.d slrb nvo|co l@ hsrre Ded sm€ c].m ttr6 &[€d lrco.r.ct fErancs c..rE€[y Address 710 NW IIH AVE Cty. Stale. Zrp OANIA. FL 33004-2315 Dorsey oare 05/05i2023 :inancial Audit Report nty d Broward Ofice of Ule Sh,e,ritr ,ClD: 5984 trrparE{r.2&gr ar9 0m (Lr&2@ 1212roFra DArENrf^nEN P.tianrNam€. NIICHALEK.GEORGE L rEcrclr.ltD LcrE€ cr@2 LlltForr.lrlarln ralrE crmr6, OOS: 6t3ot"O22 om 115a 0rrr2r@ 0' r019 Ari 0@ 2 2-r 6ir!r2@ rr12roru r,3 000 &!&?02 '? 12 roPi, 2600 06 'rprn ? rr rlrlx AnbulanceConmander+ mre.l iry (:lx)RstY nn.,i.lav Mayrr 2fi $3923PM 7tt.n iE.t0 :lectronic Remittance Report: EMOEON AcH#:42292293 ounty of Browa.d Office of the Shedff r.rm cL.mt rd ocDo d.& 08n L2022 UNIIEO HEALIHCARE INSURANCE COMPAI{Y P O. BOx loaa 9ALT LAKE CTY UT 8a13o0,aa8 Tor.l ChGk Am0t 9€6 a2 P@ Ch.g ADd O.dci ldr I roa?7RH t2256 aBn Sub Tdr 1307 32 ,oa.25G253 12 5J lor.l Numb.r olCl.im. 7 I 307 32 504 25 250 00 25112 r{.ffi urao. It! aqu$r6r tu 6d cqd lnc dr 9.l@ d .1rm .hrgcE<txtG) ,E nft Bn.d t@ O.s OaEnr) ad|urc.oo rt * dry *in crd, AmbutencaCom,nende;+ ao 251 s.qrsrrtu r.arllo. n ri<rrJ p.yrEr :O 45 Chag. c-E€d! le. *n ddd@|ru d6d!L d cEdxt.dl9nd.d tr -nEi ard rh6r nd dt]Dad. qed.r .4rEr5, ruE lDavrEns ald cdtlrrtu* :od6 FR d CO rbp.Er'{ ub shy)rR 3 C+BlEr ArlrM mled by CI|IRSEY tn Frday uiy5 20235le24PU Hrct lalch.419 ATL 865348 Transadion 10 Summsry Transaclron Total: 5OO.00 USD Oepos[Account: 4l32gg'153O Depos( Dale 10t24DOZ2 )h€cf I Ch€ck Amountr Ch6ck Account Nurnb€r: Ch6ck Numbsr: 500.m usD 29254918 8€1 ront lmaqo r: eE 7O ?8I ? 5t:OO0OO tC ? 5qq t8lp oBB ,1.18 661 oo P 4 FLORIOA t0-tl dl. ' $5000-, ocBsoqsl 24 DcBsO9'7//3 &..1,L:.fr- , @ s-:. GEORGE J MICHALEK 7 r 0 Nlfl /IH AVE oAlrla, FL33@4.23r5 at.16t1/tato 0l ffv,.Fb?n'||iM.|,.m CD lalch ,119 ATL 8A$,16 Transeclbn 10 Contnuod Transacton Total 500-@ USt) Depos Account:,1i329e1$0 Deposrl Date:10t24t2g22 dn2 'rcr lmege SROWAiO STIERIFFS 'IRE RESCUE cvebbl SHOW AMOUNT PAIO HERE V P.yment Addr.is v,t fr j cBso60o5 337533@ rltrtr,tI nIl,qrlrlrl,Ix,I,lnltnr,,r,,rt[,][,[" GEOROE MICl"lALEK !ad.'dldil*.rq.(r)dlhl'dio BRO'/ARO SHERIF'6 FIRE RE6CUE PO BOX 865346 oFLANOO, FL 32ad!53.16 PLEASE REIURN THIS PORIION wlTh YOUR PAYMENI lack lmegp '{voEE a DcaaoaTa2 Yq/ irLy.tao c{[ our otltc. tofl rl!6 sr &t3-532-?31 or vtri HllEfufllsoaLpayaMlulAitcE.coil to !rcvtd€ us with yosr inlurancc htofm€tlon. ABOUT YOU:ABOUT YOUR IISURANCE: TO PROVIDE INSURANCE II{FORMATION PIEASE VISIT HTTPSJ/ASOf A.PAYAMAUTANCE CO{I ! latch.128 ATL 865344 Transadion 47 Summary Transactron Tolalr 25O.m USD DeposrtAccounlr 410091530 Deposrt Date 1081nOZ. Ch€ck Amounll Check Account Numbei Check Numbor: 250.00 u$) 292549't 8 637 ront lmag€ r: ?E?O?81?5r:OOO00 eq lsqc l8n. OBI? t r-lE 637 6(.f lcrrlri $Zra€ FI FI t0f IloUaru @ !I,,r. G€OFGE J MICHALE( 710 NW 7TH AVE DANTA. FL 33OO4.23r5 ar r,3llLrt 'ww.n.,{.Frd.r6i )h€ck 1 latch 124 ATL 885346 Transaa on 47 Conlinued TransactDn Totalr 250.00 USD OeposrtAccounl 4132991630 D€posrt Oate 1AB1nOZ2 omt 'roart lm6g€ BAOWTRD SHERIFES FIR' RESCUE caso60o5 308630364 ,r,y'r,l,l.th,1rll!l1hl'lt,nmnlllltrr,nt,tl.tl,rl,,tr TOPROVIOE INSURANCE INFORMATION PLEASE VISIT HTTPS://BSOFR.PAYAiIBUIAI|CECOt t SHOV/ AMOUNI PA D HERE V Payment Addr€rs Vtd trl i G€ORGEM'CH'{E( caNlA Fr 33004,2315 EROWARO SHERIFFS FIRE RESCU€ PO 80X 8653a8 ORIA.DO. .1 328€6$,16 PL€ASE REIIJRN THIS PORTION WIIH YOUR PAYMENT bck lmeg€ II{YOICE ,: OCBS097a2 You |n y rtso crr our ornc. to{ 1r.! .t E33-532-2231 or lisn trEEBr/BaoFR.paya BuLA c E.co to prov(b rJsrti your Insuranc. lnfofrnaton. AEOUTYOU;ABOUT YOUR iNSURAIJCE: T-l *eddh. jd trhLl tn.rrFd nn i{ks dNolr) i ri. r!. d. 1t t