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: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name & Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4
nt U.S. Attorney/Budget Officer. PLEASE REFERENCE THE ABOVE DCN# ON YOUR INVOICE FOR PAYMENT. 12. Signature of Financial Institution Official: l2b Phone of Financial Institution Official: 13 Date Signed: Total Amount Claimed By Financial institution Section C- Receiving Report 16 Disallowance (See Attached) 14 I catty
: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing T ansit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name & Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4
t U.S. Attorney/Budget Officer. PLEASE REFERENCE THE ABOVE DCVO ON YOUR INVOICE FOR PAYMENT. I 2a Signature of Financial Institution Official: 12b Phone of Financial Institution Official: 13 Date Signed: Total Amount Claimed By Financial Institution Section C - Receiving Report 16 Disallowance (See Attached) 14 I certi
: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name & Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4
t U.S. Attorney/Budget Officer. PLEASE REFERENCE THE ABOVE DCNN ON YOUR INVOICE FOR PAYMENT. I 2a Signature of Financial Institution Official: 126 Phone of Financial Institution Official: 13 Date Signed: Total Amount Claimed By Financial Institution Section C - Receiving Report 16 Disallowance (See Attached) 14 I certi
: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name & Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4
t U.S. Attorney/Budget Officer. PLEASE REFERENCE THE ABOVE DCNO ON YOUR INVOICE FOR PAYMENT. I 2a Signature of Financial Institution Official: 12b Phone of Financial Institution Official: 13 Date Signed: Total Amount Claimed By Financial Institution Section C - Receiving Report 16 Disallowance (See Attached) 14 1 certi
: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name E. Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE
stant U.S. Attorney/Budget Meer. PLEASE REFERENCE. THE ABOVE DON ON YOUR INVOICE FOR PAYMENT. 12a Signature of Financial Institution Official: 12b Phone of Financial Institution Official: I3 Date Signed: Total Amount Chimed By Financial Institution Section C - Receiving Report 16 Disallowance (See Attached) 14 I catty
: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name 8 Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4
Assistant U.S. Attorney/Budget Officer. PLEASE RF:FERENCE THE ABOVE DCNO ON YOUR INVOICE FOR PAYMENT. 12a Signature of Financial institution 12b Phone of Financial Institution Official: 13 Date Si ed: Total Amount Claimed By Financial Institution Section C - Receiving Report 16 Disallowance (See Attached) 14 I curtly
: Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name & Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida 99 NE 4
tant US Attorney/Budget Officer. PLEASE REFERENCE THE ABOVE DCNN ON YOUR INVOICE FOR PAYMENT. 122 Signature of Financial Institution Official: 12b Phone of Financial Institution Official: 13 Date Signed: Section C - Receiving Report Total Amount Claimed By Financial Institution 16 Disallowance (See Acached) 14 I taut)
Entities connected to both Signature of Vendor's and Phone of Financial Institution

United States
LOCATIONthe Return of Service
ORGANIZATION
Department of Justice
ORGANIZATIONthe Office of Management
ORGANIZATIONthe United States District Courthouse
LOCATION
Jeffrey Epstein
PERSONPalm Beach County Courthouse
LOCATIONSouthern District
LOCATIONFBI
ORGANIZATIONThe Debt Collection Improvement Act
ORGANIZATIONSouth Flagler Drive
LOCATIONSignature of Approval
ORGANIZATION
West Palm Beach
LOCATIONJanusz Banasiak
PERSON
Alfredo Rodriguez
PERSONFBI Office
ORGANIZATIONU.S. Government Property
ORGANIZATIONthe Right to Financial Privacy Act
ORGANIZATIONI I Service/Financial Records
ORGANIZATIONSignature of Records
ORGANIZATION