Monthly Report Template
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1Manatee County Probation
Physical: 1051 Manatee Avenue West, Hensley Wing, 5
Floor
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Mailing: P.O. Box 1000 Bradenton, FL. 34206
Office: 941-749-3051 Fax: 941-742-5886
Monthly Report
ANSWER ALL QUESTIONS! This Report is due by the 5
of the month.
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OFFICER:
Borrero
Burgh
Gillerin
Graham
Green
Hilmes
Klucitas
McMahon
Miranda
IF YOU HAVE ANY QUESTIONS CONTACT YOUR PROBATION OFFICER!
Monthly Report for the month of: ___________________________ Case Number: __
__
C
HECK HERE IF YOUR ADDRESS OR PHONE NUMBER HAS CHANGED SINCE YOUR LAST REPORT
Name: _____________________________________ Home Phone: ____________________ Cell Phone: ______________________
Home Address: ___________________________________________________ City, State: _________________________________
Mailing Address: __________________________________________________ City, State: _________________________________
Are you employed?
Yes
No If Yes, Business Name: _____________________________________ Phone: _________________
Take home pay for the month $__________ How many days did you work for the month? _________ How many hours? ___________
If No, Check One
Not looking for work
I have not looked for work this month
Looking for work
I do not work because?______________________________________________________________________________________
List places where you have looked for employment in the last month
Date
Name of Company
Person Contacted
Phone
Other Source(s) of Income:
Social Security $ ________
Retirement $________
Disability $ _________
Cash Assistance $__________
Veteran’s $ ____________
Unemployment $___________
Workman’s Compensation $___________
Other, specify $______________________________
Have you made any payments to the Fines/Cost in your case?
Yes
No If No,Why?______________________________
Have you paid your current monthly probation fee?
Yes
No If No, Why? ______________________________________
Have you been ordered to complete a program?
Yes
No
If Yes, Which Program?
VIP
ACF
Anger Management
CBIP
Mental Health
Offender Work Program
DUI School
Drug Counseling
Other, Specify ____________________
Are you currently enrolled in the program?
Yes
No
If No, Why are you not enrolled? ___________________________________________________________
Are you working Community Service?
Yes
No If Yes, Where? ________________________
How many hours were you ordered to complete? _______ How many have you completed? ______
Will you be working community service hours in lieu of Fines/Costs?
Yes
No
If No, Why? _______________________________________________________________________
Have you been arrested and/or ticketed since your last report?
Yes
No
If Yes, Date (s)? __________________________ What was the charge (s)? ______________________________________________
What is the due date for your conditions of Probation? ________________________________________________________
Note: Conditions are due one month prior to your termination date.
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ACKNOWLEDGE THAT THE ABOVE IS TRUE AND CORRECT
SIGNATURE: ____________________________________________ DATE: ______________________________
LARRY BUSTLE * CHARLES SMITH * JOHN R. CHAPPIE * ROBIN DiSABATINO * VANESSA BAUGH * CAROL WHITMORE * BETSY BENAC
District 1
District 2
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District 4
District 5
District 6
District 7
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