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ent by Din Own Fontaine. EFTA00178447 GENERAL This is a multi-purpose form designed to sene as an Authorization, Purchase Oder, Itemized Invoice, Receiving Report and Payment voucher in conjunction with 'requests for fironcial information," pursuant to theRight toFinancial Privacy Act of 1978, P.L 9S-630, Tide
enrollment form. Do not proceed with compliance: If cost will exceed Moll without prior approval of 0.25 11.00 17.00 Copy Hour Clerical Tech Hour Manger or Supervisor Budget Officer liatir0 FtlICIAIRL Fax any request to (305) 530-7670 12 Signature of Financial Institution Official: 13 Date Signed
iln Fococol Forms. Inc EFTA00178603 GENERAL This is a multilximose form designed to sene as an AllthOffrIll ion, Purchase Oder, Itemized Invoice, Receiving Report and Payment voucher in conjunction with "requests for firencial information," pursuant to the Right to Financial Privacy Act of 1978, P.L. 95430, Ti
ollment form. DO not proceed with compliance: If cost will exceed 5500 without prior approval el to 0.25 11.00 17.00 Copy Hour Clerical Tech Hour Manger or Supervisor Budget Officer Lazar* Felicia's.. Paz any request to (305)530-7679 12 Signature of Financial Institution Official: 13 Date Signed:
08-80736-CV-MARRA P-000234 EFTA00227614 GENERAL This is a multiputpose form designed to sent man Authorization. Purchase Oder. Itemized Invoice, Receiving Report and Payment voucher en comenceon with 'Fewest for fun gal Mr0111111t, pursuant to the Right *Financial Pnvacy Act of 1971. P L 95-630, Tide XL 12U
lic Law 9S-620 (12 U.S.C. 3401.3422) Request Pursuant To: (arectate 0400 SECTION 22 Remarks IS Dos Recited: 0.25 1100 17.00 How Oedcal Tech Hour Manger or Superstar To - tal A mou iClaimed By I- inarnial Institution 16 oran...... Arsacht 17 -N et to Financial Institution 0.00 OBJECT CL
ORM 0110-211 APR. 84 EFTA01660251 • GENERAL This is a multi-purpose form designed to sane as an Authorization, Purchase Oder, Itemized Invoice, Receiving Report and Payment voucher in conjunction with 'requests for financial information, pursuant to the Right toFinancial Privacy Act of 1978, P.L. 95430, Tide
enrollment form. Do not proceed with compliance: If cost will exceed 5500 without prior approval of 0.25 11.00 17.00 Copy Hour Clerical Tech Hour Manger or Supervisor Budget OM/. 'Fax any request to 005)530.7679 12 Signature of Financial Institution Official: 13 Dat Signed: Total AmountClaimed
Entities connected to both Receiving Report and Hour Manger
South Flagler Drive
LOCATIONthe Southern District
LOCATIONthe Return of Service
ORGANIZATIONSignature of Records
ORGANIZATION
Alexander Acosta
PERSON
United States
LOCATION
Jeffrey Epstein
PERSONFBI
ORGANIZATIONSignature of Vendor's
ORGANIZATION
West Palm Beach
LOCATION
Department of Justice
ORGANIZATIONThe Debt Collection Improvement Act
ORGANIZATION
U.S. Treasury
ORGANIZATION
George W. Bush
PERSONJanusz Banasiak
PERSONClaudia Castellanos
PERSONOLY-39
ORGANIZATION
Budget
ORGANIZATIONDepartmc
PERSONChase Bank USA
ORGANIZATION