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HomeMy WebLinkAboutInv# ACID6504 - GEORGE J. MICHALEK - 05/05/2023fro SROWARD SHERITIS FIRE R6CUI 260I W, BROWAflD BLVD TORI IAUDERDAI.f, FI- 333I2 For Ouestions Contact th6 refund d6p6nmenl R6fu nds@OrgrtechCompuier com Erlilauation ol' Rrtirnrl Palient Mrchalok.George Pohcy lD+ SgMc€ Date Claim Ref# o7 to6t2022 INVOICE DCBSO9743 PAID IN AC|D AC|D 6504 Relund Amounl -250 00 lssu€ Chsc* Payarrh to: Paye€ G€orge J Michalot RaspdBt lu p*t p6n 6nd iHr6E pad ReslonsOlo prry o5*! sdE irc irco lBrac.9ad sam cbm lw Bllod lfEo.r..r 'ns(l@ @r94y AddIesS 710 NW 7TH AVE Crty Stale. Zrp OANIA. FL 3300,1-2315 Requesled by Cynflla Dale 05/05/2023 :inancial Audit Report omty of Bonad O'ffice of fte Sherifl prtirl itri|€r MICI.TALEK GEORGE Uur€Dilr uratD lcreE cirEsl DOS: 7 6?022 0m Er a9 (,,'!2@ 4507$Arr 0 07/r12{p? 07 15 29 Ptl 0m 5151 07r1r@ (E 07 {r ^n 00 z.om (!r&n 2 r?rlrrBi @rndlz 4.2n8 6.rEor(?AAE iall rt r) pa\.fxi r2*2tl 2r9 I 0 c6 6i3nu rl r2 ro pr 0 (Elr&m 6z6nr 06 060 Eillaz2 1212r!pr r5r)paYr€{rr4923! aa oco (!li[?{a2 r? 12 r P a q1qn22 $m$it Anbutenceconhehde.+ ,ClD: 5504 7'1918 !@.tr :lectronic Remittance Report: EMOEON ACH#:42292293 ounty of Brow'ard Office of the Sheriff r.rh cl.rh! lor o.903il d.r. 0& t ,/2022 UNIIEO HEAI. TI.|CARE IN3URANCE COiPAIIY P O BOX JO{a SAIT LAKE CTY Ur 841300444lot lChkkAtuunt 946.a2 oos ChrC ApFr O.dkl lovr AOa2TRn 1225 66 lttn sla rd, 1t07 12 zr9Ja Tot.r Numa.r olCl.am. i 3!7 82 ,i.25 0oo 250 00 2a9 ra :o 2t3 S.qr$rm cdllo.r n tffi p.yrBi :oa5 chrc. Ed le. *lledrrd,'ratlu.xoda€ 6 6rr..rd!.{]ir*d b -.l.rEr u!+ Thr.4r$rEr roir dmr.qE dEE ffi r.l-n dE!.,!et 't6.rEl h.r dqk& s6 ,.r.q6tEr rrc{nB (FrEts rn.qrf..td rld&Brrdn Gsn dtm9.up.lln3)aqlracadr lue cit 'dr Grq,:!d6 PR a CO d.9..c.e llM lolry),R 3 Coo.riFlArBd Arnbulancebmmandei+ 2 lalch 4t9 ATL 865346 Transacdon l0 Sumrnary Transacton Tolatr 5@-00 USO DoposnAccounl:,i132$J530 Deposrt Date 10t24no22 lh€ck 1 Check Amountr Ch6ck Account Number Check Number: 5m.m uso 2925,{918 88'l ronl lmege r: lE?O?B 3 ?5r:OOOOO eg 25r,C l8'F OEE oot oo PE r 4 $5000! Fl ',,," ocBs091 2+ pcaSoi1r13 t0 -t2- 8.lls:.r!- " @ gr:. GEONGE J iIICHALE( 7IO NW 7IH AVE oaNla. FL 3J@4-23t5 6r.?t'11610 gl latch:419 ATL 86$/ro Transadon l0 Condnu6d Transaclion Total 5{n.m USD DeposrtAccounlr 4132991530 D€posrt Date 1U24nO22 orn I 'Iont lmsg€ 0 AROWARO SHEFIFFS FLRE RESCUE .,J dl 5 . dA*bbl IO PFOVIDE ]NSUFANCE INFORMATION PLEASE VISIT HTTPS://ASOFR.PAYAMBUIANCE.COTVI SHOYJ AMOTJN' PA O HEPE t Prymrnt Addr.ss v AROVI/ARD SHERIFFS FIFE RESCUE PO rcX 845346 oRLANOO. Ft t2846.5346 h- turd .d i.k .r.{'(.) 6 ,i. ,?!E 6.PLEASE RETURN'THIS PORIION Y/IIH YOUR PAYMENT laci lmeg6 lliVOlCE r: DcEtotrat You may cbo c.ll our o ct tol rr!. d 033-532'223I o. vlti EEEIi/lElQE&EAIAUBllilIqElqQ to Fovil usilh you, lmuranco intofiralion ABOUT YOU:ABOUT YOUR INSURAT{CE: aBso{527 337583869 GEORGE MlCHALEK lANra FL 33004-2315 ! latch 123 ATL 8A$,6 Transadbn 49 Sumrnary Transacton Total 250.m USO D€posnAccountr,4i34991530 Deposrl Dal€10t31t2022 :heci I Chack Arnount: Ch6ck Account Numbor Check Number: 250.00 usD 29254918 (x}9 ront lmeoe r: e B ?O ?8:l 2 SI:OOOOO ?q Z 5qq lSrF O 1 1 .18 W9*ru*u'. I Ior $ :y),r no[us O S1 GCOAGE J NICHALEK 7ro tlti 7TH AVE DANTA, FL 3300..2315 639 0l 6r.!!.q|-,!!-. fil.lhdrJr.'I.,m &dr,r-* letch ockbox 124 ATL 8653/tti TEnse{iim 49 Corninu€d Transacion Total: 25O.@ USD OeposilAccount 4,l32391530 Deposrl Date 10t3112U22. ran I ',Ent lnra€a x T.J!l i o Biora/ Fo sltER.FFs nnE nEscuE TO PROVIDE INSURANCE INfORMAIION PLEASE VISIT HTTPA//ESOFR.PAYAMSULANCE,COM sHowAMouNT PAD FERE s era. z V PrymcntAddrcss VcBso 6527 308830365 GEORGE MIC'IALEK oaNta FL 33004-2315 hBd'ldn{.'eo.t trr.(.) oo i, Bd .Jr. BRCA/VARO SFERIFFS FIAE RESCL'E PO DX t!5346 oRLANoo, FL 3286&53rn' PLEASE REIURN iIIIS PORTIO WftI YOUR PAYMENT tack lmage I|lvOCE l: ocAaoata! Yo! llEy .5o c.I oo. ofico lor tsc n $s-532-223r d 6t UIIEI;/ lEeEllEAtrAll8lLlliEECO ro prDyir. u! wan ,our inau,lnc. nlorndion ABOUT YOU:ABOUT YOUR INSURANCE: .l Refund Request PAYEE NAME| George J Michalek ADDRESS 710 NW 7TH AVE DAN|A. FL 33004 2315 Cily Stale z'p rNvorcE DcBSo9742 PA|O rtl 5984 515t2023 -250.00 TNVOtCE DCBSO9743 PA|O rt{6504 515t2023 -250.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -500.00 RoL AC ID INVOICE OATE lNEr A ouNr ri --.t =H