Fedex Commercial Invoice – Fill Out and Use This PDF

PROB 8

(Rev. 09/00)

U.S. PROBATION OFFICE

MONTHLY SUPERVISION REPORT FOR THE MONTH OF

, 20

.

Street Address, Apt. Number:

Own or Rent?

Home Phone:

Cellular Phone:

Pager:

City, State, Zip Code:

Persons Living With You:

Secondary Residence

Own or Rent?

Did you move during the month?

9 Yes 9 No

If yes, date moved:

Reason for Moving:

Mailing Address (if different):

E-Mail Address

Name, Address, Phone No. of Employer:

Name of Immediate Supervisor:

Is your employer aware of your

criminal status:

9 Yes

9 No

How many days of work did you miss?

Why?

_________________________________________________________________

Position Held:

Gross Wages:

Normal Work Hours:

Did you change jobs?

9 Yes

9 No

If changed jobs or terminated,

Were you terminated?

9 Yes

9 No

state when and why:

PART C: VEHICLES (List all vehicles owned or driven by you)

1.

Year/Make/Model/Color:

Mileage:

Tag Number:

Owner:

Vehicle I.D.#:

2.

Year/Make/Model/Color:

Mileage:

Tag Number:

Owner:

Vehicle I.D.#:

PART D: MONTHLY FINANCIAL STATEMENT

Net Earnings from Employment:

Do you rent or have access to:

a post office box?

9 Yes 9 No

a safe deposit box?

9 Yes 9 No

(Attach Proof of Earnings)

a storage space? 9 Yes

9 No

Other Cash Inflows:

Name and Address of Location:

Box No. or Space

TOTAL MONTHLY CASH INFLOWS:

TOTAL MONTHLY CASH OUTFLOWS:

Do you have checking account(s)?

9 Yes 9 No

Does your spouse, significant other, or dependant have a checking or savings

Bank Name:

account that you enjoy the benefits of or make occasional contributions

toward?

Account No:

Balance:

9 Yes 9 No

Do you have savings account(s)?

9 Yes 9 No

Bank Name:

Bank Name:

Account No:

Balance:

Account No:

Balance:

Attach a complete listing of all other financial account information, if you have

multiple accounts.

List all expenditures over $500 (including e.g., goods, services, or gambling losses)

Date

Amount

Method of Payment

Description of Item

PROB 8

(09/00)

Page 2

PART E: COMPLIANCE WITH CONDITIONS OF SUPERVISION DURING THE PAST MONTH

Were any pending charges disposed of during the month?

Was anyone in your household arrested or questioned by law enforcement?

9 Yes

9

No

9 Yes

9 No

If yes, date:

If yes, whom?

Court:

Reason:

Disposition:

Disposition:

Do you have any contact with anyone having a criminal record?

Do you possess or have access to a firearm?

9 Yes

9

No

9 Yes

9 No

If yes, whom?

If yes, why?

Did you possess or use any illegal drugs?

Did you travel outside the district without permission?

9 Yes

9

No

9 Yes

9 No

If yes, type of drug:

If yes, when and where?

Do you have a special assessment, restitution, or fine?

9 Yes

9 No

If yes, amount paid during the month:

Special Assessment:

Restitution:

Fine:

____

U.S. Probation Officer

Date