Manatee County Probation Monthly Report

This report is due by the 5th of the month.

If you have any questions, contact your probation officer.

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Officer

Month

Case Number

Has your address or phone number changed since your last report?

My address has changed

My phone number has changed

Home Phone

Cell Phone

Is your mailing address different from your home address?

Yes

Are you employed?

Yes

Business Name

Business Phone Number

Take home pay for the month

How many days did you work for the month?

How many hours?

Check One

Not looking for work

I have not looked for work this month

Looking for work

I do not work because (explain below)

I do not work because

List places you have looked for employment in the last month. (Include Date, Name of Company, Person Contacted and Phone Number)

Other Source(s) of Income

Social Security

Retirement

Disability

Cash Assistance

Veteran's

Unemployment

Workman's Compensation

Other (Write below)

Specify other source(s) of income

Social Security Amount

Retirement Amount

Disability Amount

Cash Assistance Amount

Veteran's Amount

Unemployment Amount

Workman’s Compensation Amount

Other Amount

Have you paid your current monthly probation fee?

Yes

Why?

Have you made any payments to the Fines/Cost in your case?

Yes

Why?

Have you been ordered to complete a program?

Yes

Which Program? (If other, write in last box)

VIP

ACF

Anger Management

CBIP

Mental Health

Offender Work Program

DUI School

Drug Counseling

Are you currently enrolled in the program?

Yes

Why are you not enrolled?

Are you working Community Service?

Yes

Where are you working community service?

How many hours were you ordered to complete?

How many hours have you completed?

Will you be working community service hours in lieu of Fines/Costs?

Yes

Why?

Have you ever been or are you currently employed by Manatee County Government?

Yes

Have you been arrested and/or ticketed since your last report?

Yes

Date(s) of arrest

What was the charge(s)?

I ACKNOWLEDGE THAT THE ABOVE IS TRUE AND CORRECT

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.