EFTA00181807

Case 9:08-cv-80119-KAM 
Document 305-9 
Entered on FLSD Docket 09/17/2009 
Page 3 of 3 
Page 6 
1 
my client's intent specifically, because I also 
2 
advised him that he was not to cross paths, not 
3 
to have any contact with your client, and 
4 
certainly by our agreement not to be here today 
5 
for the deposition. 
6 
MR. HOROWITZ: And at approximately 1:00 
7 
is exactly when my client crossed paths with 
8 
Jeffrey Epstein. And not only did he cross 
9 
paths but he proceeded to stare her down just 
10 
feet away from her. For that reason she became 
11 
an emotional wreck and cannot proceed with the 
12 
deposition. She's simply not in an emotional 
13 
state to do so. 
14 
And in addition Mr. Epstein violated the 
15 
agreement between counsel that he would not 
16 
cross paths or come into contact with our 
17 
client And it will be also for the criminal 
18 
court judge to deckle whether he has violated a 
19 
no-contact order. I have nothing else to say. 
20 
MR. CRIITON: Again I instructed 
21 
Mr. Epstein to leave the building so absolutely 
22 
no contact could occur between he and 
23 
Mr. Horowitz and his client nor anyone else. 
24 
Until the court, until either Judge Marra or 
25 
Judge Johnson ruled on the issue as to whether 
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Page 8 
CERTIFICATE 
STATE OF FLORIDA 
COUNTY OF PALM BEACH 
I, Cynthia Hopkins, Registered Professional 
Reporter and Florida Professional Reporter, State of 
Florida at large, catify that I was authorized to 
and did stenographically report the foregoing 
proceedings and that the transcript is a true and 
complete record of my stenographic notes. 
Dated this 16th day of September, 2009. 
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Page 7 
or not he could appear at the depositions of 
not only Jane Doe 4 but any other individuals, 
so you do what you need to do. 
MR. HOROWITZ Off the record. 
(The Deposition was concluded.) 
3 (Pages 6 to 8) 
(561) 832-7500 
PROSE COURT REPORTING AGENCY, INC. 
Mectionicatly signod by cyntNa hopkIns (6014514076-2934) 
d2 a4313•34.50-4246-94414348742M9•5 
EFTA00182067

Came:Dp-o2ry 1110%bp 
Document 305-10 
Entered on FLSD Docket 0947/2019 PP43e 1 of 2 
Prose Court Reporting Agency, Inc 
One Clearlake Centre 
250 South Australian Avenue, Suite 1500 
Beach,
phone 
Fax 
Tax ID: 
www.prosecre.com 
September 17, 2009 
Robert Critton, Esquire 
Burman, Critton, Luther & Coleman - WPB 
303 Banyan Boulevard 
Suite 400 
West Palm Beach, FL 33401 
Re: Jane Doe No. 2 vs. Jeffrey Epstein 
9-16-09 Scheduled Deposition of Jane Doe No. 4 
Statement for Record 
Description of Services 
Depo App NT- 1st Hr 
Appearance 1st Hr 
Depo Trans 0&1-Reg 
Transcript Pages - 
E-transcript EmalIed 
Complimentary 
Invoice Number 
CH 411 
110.00 
28.80 
Invoice total: 
$138.80 
Thank you for choosing Prose Court Reporting Agency, Inc. Payment is due upon receipt. 
EFTA00182068

8 3E&P9k38-411981 
ent 305-10 
EXgred on FLSD Docket 09).1P7.412539 IPPabeei loet22 
'VISU'AL 
EVIDENCE 
La. sox 0167 Wait Pan bath, EL 33405 
BURMAN, CRITTON & LUTTIER 
ROBERT CturroN 
303 BANYAN BLVD 
. 
SUITE 400 
WEST PALM BEACH, PI. 33401 
Invoice 
Date 
Number 
9/17/2009 
28616 
Tenn 
Due on receipt 
Case / Reference: 
JANE D00 02 v EPSTEIN 
Date 
Rinke, Rendered 
4200
Amount 
9/16/2009 VIDEOTAPED DEPOSITION OF: JANE DOE e 4 
Tech Time • 1ST 2 Hon 
1 
275.00 
Digital Tape Scodt 
15.00 
MASTER TAPE CONSISTS OF DISCUSSIONS BETWEEN ATTORNEYS PRIOR 70 SWEARING IN 
REGARDING CANCELUTION OF DEPO. 
9/17/2009 Delivery 
1 
0.00 
MASTER TAPES FORWARDED PER YOUR REQUEST. NO COPIES HAVE BEEN MADE OR KEPT ON 
FILE AT VISUAL EVIDENCE SHOULD COPIES BE REQUIRED IN THE FUTURE PLEASE FORWARD 
MASTER TAPS TO OUR OFFICE FOR DUPLICATION. THANK YOU. 
MORE THAN JUST VIDEO I See ALL available presentation 
technology services at writv.vlsweetelcianctor*, 
TOTAL: 
$290.00 
Remit to: 
P.O. Bac 6967 
west Palm Beam, H. 33405 
Tax ID * 59-2476529 
Phone: (561) 655-2855 
Roc (561) 655-2996 
of ceovIsualerldence.org 
EFTA00182069

C .
Case 9:08-cv-8011 9-KAM 
Document 305-11 
Entered on FLSD Docket 09/17/2009 
Page 1 of 2 
UNITED STATES DISTRICT COURT 
SOUTHERN DISTRICT OF FLORIDA 
CASE NO.: 08-CV-801I 9-MARRA-JOHNSON 
JANE DOE NO. 2, 
Plaintiff, 
v. 
JEFFREY EPSTEIN, 
Defendant. 
Related Cases: 
08-80232, 08-80380, 08-80381, 08-80994, 
08-80993, 08-80811, 08-80893, 09-80469, 
09-80581, 09-80656, 09-80802, 09-81092. 
ORDER ON DEFENDANT'S. JEFFREY EPSTEIN, MOTION FOR SANCTIONS 
AND TO COMPEL DEPOSITION OF JANE DOE NO. 4 
AND MEMORANDUM IN SUPPORT THEREOF 
This matter came before the Court on Defendant's, JEFFREY EPSTEIN, Motion For 
Sanctions and to Compel Deposition of Jane Doe No. 4. Having considered Defendant's motion, 
it is HEREBY ORDERED and ADJUDGED that: 
Defendant's motion is hereby GRANTED: Plaintiff shall pay sanctions in the amount of 
 
 in costs and $ 
 in fees directly to Burman, Clifton, Luther and 
Coleman within 10 days, and further directs that the Plaintiff make herself available for 
deposition no later than October 
, 2009 beginning at 9:30 am. at the same location. Mr. 
Epstein shall not be present in the building on the day of the deposition absent a court order on 
pending motions. 
EFTA00182070

Case 9:08-cv-80119-KAM 
Document 305-11 
Entered on FLSD Docket 09/17/2009 
Page 2 of 2 
Jane Doe No. 4 v. Epstein 
Page 2 
DONE and ORDERED this 
day of 
, 2009. 
Kenneth A. Marta 
United States District Judge 
Courtesy Copies: Counsel of Record 
EFTA00182071

STATE OF FLORIDA 
vs. 
JEFFREY E EPSTEIN, W/M, 01/2011953, 
IN THE CIRCUIL COURT OF THE FIFTEENTH JUDK.aAL CIRCUIT 
IN AND FOR PALM BEACH COUNTY, STATE OF FLORIDA 
CRIMINAL DIVISION 1'W" (LB) 
OVCF932/ 
ARISES FROM BOOKING NO.: 
2006036744 
INFORMATION FOR: 
1) 
PROCURING PERSON UNDER 18 FOR PROSTITUION 
ce? 
In the Name and by Authority of the State of Florida: 
GI 
BARRY E. KRISCHER, State Attorney for the Fifteenth Judicial Circuit, Palm Beach gasty:TIorida, by and 
through his undersigned Assistant State Attorney, charges that JEFFREY E EPSTEIN on or about or between 
the In day of August in the year of our Lord Two Thousand and Four and October 9, 2005, did knowingly and 
unlawfully procure for prostitution, or caused to be prostituted, A.D, a person under the age of 18 years, 
contrary to Florida Statute 796.03. (2 DEG FEL) 
STATE OF FLORIDA 
COUNTY OF PALM BEAC 
Appeared before me, 1 
Florida, personally known to 
foregoing information are base 
the offense therein charged, tha 
oath has been received from the 
Sworn to and subscribed to 
0
?iht. 
Clamart Ph 
InCommiSsico Doses . alto 
LB/dp 
August 2. 2010 
. 
D'IDED Mit ?POT aiN PalitANCE SC 
FL BAP • " 
726 
ney 
NOTARY PUBLIC, 
-(:IC REFERENCE NUMBERS: 
, FELONY SOLICITATION OF PROSTITUTION 3699 
uney for Palm Beach County, 
allegations as set forth in the 
and which, if true, would constitute 
ad certifies that testimony under 
to of Florida 
CA) 
ft pi.1 • e 
EFTA00182072

STATE OF FLORIDA 
DEPARTMENT OF CORRECTIONS 
Caseload Transaction Register Data Entry Form
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OFFENDER NAME , 
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COMMENTS 
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EFTA00182073

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EFTA00182074

PHOTO 
OT71 
1O736 
Li INSTRUCT 
STATE OF FLORIDA 
DEPARTMENT OF CORRECTIONS 
OFFENDER INFORMATION SHEET AND REPORTING INSTRUCTIONS 
Official Name: EP syc.:70,.) 
(L 
Initial/Suffix) 
DC#: 
Race 
Sex 
Date of Birth 
Social Security # 
True Name: 
Alias/Nickname 
(Last, First, Middle Initial, Suffix) 
Maiden Name 
11
Eye Color 
Body Build 
Birth City /County 
(L. 
Height- Ft/In. 
Weight 
Lc) 
 
(LC, 
Complexion 
Hair Col6r 
Sca ns/Marksfrattoos - Description and Location 
N(0! 
✓C 
Birth State 
Birth Country 
Citizenship 
Ethnic 
Primary Language 
‘-t er 
Religion 
Understand English? 
Marital Status 
Highest Grade Completed 
Offender Address ( PRESENT): 
170(p. y 
Dr 1 
c. 
County 
Street Address 
State 
Homo Phone 
Phone and Cell 
Significant Other. Name 
Relationship 
 Phone  
Next of Kin/Significant Other: Street Address:  
City 
Mother's/ Malden Name:  
Glees 
Mother's and/or Father's Street Address: 
City 
Mother or Fathers phone number, including area code: 
Employer's Name (Primary):  ./t. Ca' 14" CI we A-41%.• straitAddress: 
•
`1t 17
State 
State 
2$' 
Arid r foie /Vol. 
City 
State 
Zip 
Work Telephone 0 
Length of Time Employed 
Begin Date (Month/Year) 
ti 
Primary Duty 
Industry 
Supervisor's Full Name 
OFFICE OF SUPERVISION REPORTING INSTRUCTIONS 
REPORT TO THE PROBATION OFFICE INDICATED BELOW AND PRESENT THIS FORM TO THE OFFICE RECEPTIONIST. FAILURE TO 
REPORT IS A VIOLATION OF YOUR SUPERVISION. 
REPORT ON: 
 AT:  
CT
(Date) 
(Time) 
"*) 
lender Signature/Date ackno (edging receipt of reporting Instructions. 
Intake Personnel Signature/Date 
!ices. 
DC3-297 (Revised 5/06) 
EFTA00182075

INITIAL REPORTING INSTRUCTIONS 
(Provided by the Circuit Court of Palm Beach County) 05'7 'IS
4E-Frf-
Af Eras 7- g 
(Offender Name) 
Supervision Type: 11 Probation pi Drug Offender Probation 
Community Control K Sex Offender Probation 
K Sex Offender Community Control 
You are instructed to report to the following Department of Corrections 
office located at: 
Office Address: 3444 South Congress Avenue 
Lake Worth Florida 33461 
Office Telephone Number: 
Date and Time to Report: . 
IM0VOIATiq _.f.errs4 OISITTYeECSTP2-
Office Hours are from 8:00 AM - 5:00 PM, Monday through Friday. 
Failure to report as instructed is a violation of the terms of 
supervision, as provided in Sections 948.03 and 948.06 Florida 
Statutes. 
Race/Sex:  CO / '44  DOB:I 
Address: 35- g 
f .c-
Phone #: 
SS # 
c'eL 
Ind. P J, F/J-t4, 
VE51 
JUL 18 2008 
I 
15-4 
DC3-298 (Revised 08/04) 
Section 6-Offender File 
EFTA00182076

STATE OF FLORIDA 
"?.PARTMENT OF CORRECTIONS 
AUTHORIZATION AND RELEASE OF INFORMATION 
TO WHOM IT MAY CONCERN: 
1,  
 hereby authorize and request every 
- - 
personi firrn, officer, corporationr associaiion,-orgartization, or institution- having control o€-a$y 
documents, records, or other information pertaining to me, to furnish the originais or copies of 
any such documents, records, and other information to the Florida Department of Corrections or 
any of its representatives, to inspect and/or to copy any such documents, records, or other 
information. 
itness/Date 
Witness/Date 
Wor 
(41- ti 
Race/Sex 
e/Date 
j - 
Date of Birth 
AUTORIZACION Y RELEVAMIENTO DE INFORMACION 
A TODO QUIEN LE CONCIERNE: 
Yo, 
, por este medio autorizo y pido a toda persona, 
agencia, oficial, corporacion, asociacion, organizacion o institucion teniendo control sobre algun 
documento, archivo, u otra informacion perteneciente ami, que provea los documentos, archivos 
y otra informacion al Departamento de Correccion de la Florida o cualquier de su representates 
para que inspeccione y/o torne copia de tales documentos, archivos, u otra informacion. 
Testigo/Fecha 
Firma/Fecha 
Testigo/Fecha 
Raza/Sexo 
Fecha de Nacimiento 
(Release valid for six (6) months from date signed) 
(Este relevamiento es valido por (6) meses de la fecha firmada) 
DC3-214 (E/S) (Revised 7-02) 
EFTA00182077

Ara" 'JAI Wilt" "no 'AUL, I1V11O 
OFFENDER'S N 
• 
CPSTE 
DC#: 
PLEASE READ AND INITIAL EACH INSTRUCTION: 
01,
YOU ARE REQUIRED TO REPORT TO YOUR ASSIGNED OFFICER EACH MONTH, UNLESS 
_ .0THERWISE.INSTRUCTED: 
. 
YOU ARE REQUIRED TO REPORT UNTIL YOU ARE NOTIFIED IN_WRT.TING OTHERWISE BY HE 
JUDGE OR YOUR OFFICERS. NO ONE ELSE HAS THE AUTHORITY TO EXCUSE YOU FROM 
REPORTING. 
IF YOU ARE CHARGED WITH VIOLATION OF PROBATION, REGARDLESS OF WHETHER YO 
ARE ARRESTED, RELEASED OR SIMPLY GIVEN A NOTICE TO APPEAR, YOU MUST CONTINUE 
TO REPORT AND SATISFY ALL YOUR OTHER CONDITIONS OF PROBATION/COMMUNITY 
CONTROL. 
IF YOU ARE UNABLE TO PAY ANY OF YOUR MONETARY OBLIGATIONS CONNECTED WITH 
PROBATION/COMMUNITY CONTROL OR ANY CONDITION OF PROBATION/COMMUNITY 
CONTROL (SUCH AS DRUG TREATMENT OR A COURSE YOU MUST TAKE), YOU MUST MAKE 
YOUR BEST EFFORTS TO SATISFY THAT CONDITION. FOR EXAMPLE, GO TO THE CLASS 
WITHOUT PAYING, KNOWING THAT YOU WILL PAY LATER). IF YOU ARE NOT PERMITTED TO 
SATISFY AN OBLIGATION BECAUSE YOU CANNOT PAY, REPORT THIS AT ONCE TO YOUR 
PROBATION OFFICER, WHO WILL TRY TO HELP. YOU MUST CONTINUE TO REPORT AND 
SATISFY ALL YOUR OTHER CONDITIONS OF PROBATION/COMMUNITY CONTROL. 
IF YOU. HAVE A POSITIVE DRUG TEST, YOU MUST CONTINUE TO REPORT AND SATISFY 
YOUR OTHER CONDITIONS OF PROBATION/COMMUNITY CONTROL. 
IF YOU ARE TAKEN INTO CUSTODY BY INS OR BORDER PATROL UPON RELEASE YOU ARE 
REQUIRED TO REPORT TO YOUR OFFICE AND TO SATISFY ALL YOUR OTHER CONDITIO 
OF PROBATION/COMMUNITY CONTROL. 
IF YOU FAIL TO COMPLETE TREATMENT YOU MUST CONTINUE TO REPORT AND TO SAT 
ALL OTHER CONDITIONS OF PROBATION/COMMUNITY CONTROL 
I HAVE CAREFULLY READ EVERY INSTRUCTION ABOVE AND I HAVE DISCUSSED THEM 
ALL WITH MY PROBATION/COMMUNITY CONTROL OFFICER AND I UNDERSTAND ALL OF 
THEM AND WILL OBEY ALL OF THEM. 
OF. 
6
er
PROBATION/ 
CONTROL OFFICERS NA 
/ DATE 
EFTA00182078

Department of Corrections' Notice of Privacy Practices 
Effective Date April 14, 2003 
FOR OFFENDERS ON COMMUNITY SUPERVISION 
THIS NOTICE' DESCRIBES HOW MEDICAL INFORMATION ABOUT 
OFFENDERS MAY BE USED AND DISCLOSED AND HOW AN OFFENDER 
CAN GET ACCESS TO THIS INFORMATION. 
PLEASE REVIEW IT 
CAREFULLY. 
The Department of Corrections (DOC) is required by law to maintain the privacy of protected 
health information (PHI) maintained in DOC offender files. Federal law requires that this Notice 
be provided to you and that DOC abide by the terms of the Notice. 
DOC Disclosures of Protected Health Information 
In performing supervision activities, DOC uses and discloses (shares) PHI maintained in offender 
files for several purposes and is authorized to do so without first getting your written approval. 
These purposes include: 
• 
For treatment activities required as a condition of probation/supervised release. For 
example, DOC may refer you to a health care provider so that you can participate in 
treatment as a condition of probation/supervised release. 
• 
For DOC payment activities. Appropriate DOC staff must confirm treatment provided to 
you pursuant to a contract in order to authorize payment. 
• 
For DOC operations. 
For example, DOC staff may discuss your participation in 
treatment with a treatment provider in order to supervise your compliance with your 
probation order. 
• 
DOC will disclose PHI when required by law. 
• 
DOC may provide information to government officials who oversee public health or who 
are dealing with threats to public safety from mica& products, dices) gel, abuse, neglect, 
domestic violence and other crimes. 
• 
DOC will provide information in the form of substance abuse test results, participation in 
court-ordered treatment programs, and other similar types of information to the 
sentencing court during the course of supervision and in the case of a violation of a 
condition of probation. 
• 
DOC will disclose PHI in response to a subpoena, or court or administrative order. 
• 
DOC may disclose PHI for law enforcement purposes. 
• 
DOC may disclose PHI to correctional facilities or in other law enforcement custodial 
situations in the event that you are taken into custody or incarcerated. 
• 
DOC may provide information to licensed researchers who are under strict rules 
regarding how they use and disclose PHI. 
• 
DOC may provide health information as otherwise authorized by law. 
' This Notice is provided pursuant to 45 CFR § 164.520, a regulation promulgated to implement the Health 
Insurance Portability and Accountability Act (IIIPAA). 
Page 1 of 3 
EFTA00182079

Department of Corrections' Notice of Privacy Practices 
Effective Date April 14, 2003 
No other uses and disclosures of your PHI will occur without your written authorization. And 
if you sign such an authorization you have the right to cancel it any time provided you submit 
a written revocation of the authorization. (45 CFR § I64.508(bX5)) 
Your Rights Regarding Your Protected Health Information 
Under the law, you have the right to: 
• Request restrictions on some of the ways DOC or its contract health care providers use 
and disclose your PHI. These restrictions can go beyond the restrictions already in the 
law. However, DOC or the contract provider may not always agree and is not required to 
implement these additional restrictions. 
• Receive confidential PHI communications. While DOC or a DOC contract provider 
cannot promise to communicate health information in every possible way that an offender 
might request, we will work with you to find a practical way of communicating PHI to 
you in strict confidence if you wish. 
• Inspect and get copies of your PHI in records maintained by health care providers who 
provide you treatment pursuant to a contract with DOC by making a request in writing. 
The provider may charge a reasonable fee to cover only the cost of providing this 
information. Note that DOC does not maintain any medical records or medical files on 
offenders. 
• Request that DOC contract health care providers amend or correct your PHI in files 
maintained by the provider. To make such a change, DOC contract health care provider 
may ask you to make the request in writing with a description of the reason you want 
your record changed. The provider may not always agree and is not required to agree to 
such requests. 
• 
A list of DOC or DOC contract provider disclosures of your PHI for a certain period of 
time (not to exceed a 6 year period since 4/14/03) that were not authorized by you and 
that were not related to treatment, payment and operations. 
Questions about DOC privacy procedures should be directed to the DOC Privacy Officer at 
 
. Complaints to DOC about the way DOC handles your PHI, compliance with 
HIPAA (see footnote, p.1 of this Notice), or if you believe your privacy rights have been violated 
must be filed as Offender Grievances pursuant to Rule 33-302.101, Florida Administrative Code. 
A copy of the Offender Grievance Procedure may be obtained from your Correctional Probation 
Officer. You may also contact the Secretary of the U.S. Department of Health and Human 
Services. There will be no retaliation against you for filing a complaint or for making requests 
regarding your health care information. 
DOC reserves the right to change the terms of this Notice and to make new notice provisions for 
all PHI that DOC maintains. If the terms of this notice are revised, DOC will provide you a copy 
of the revised Notice on your next visit to the Probation Office. At any time, anyone has a right 
to get a paper copy of the latest version of this Notice by asking your Correctional Probation 
Officer. 
Page 2 of 3 
EFTA00182080

Departr ant of Corrections' Notice of Pr' Icy Practices 
Acknowledgement of Receipt 
I received a copy of DOC Notice of. Privacy Practices for Offenders on Community Supervision. 
I understand that if DOC uses my personal health information in a manner that is different than 
described by the Notice, DOC must first get my permission in writing. 
EP 
- 
Print Offender's Name 
DC 
Number 
Signature of Offender 
date 
• Officer's Signature 
date 
Mg -1(1AX t7ICII% .
. 
• 
Page 3 of 3 
0 - 
c 
EFTA00182081

CRIMINAL REGISTRATION 
673 FAIRGROUNDS R 
WPB, FL 33411 
PHONE: 
DATE: 
REGISTRANT: 
OFFENSE: 
COURT DATE OF SENTENCING: 
SENTENCE IMPOSED: 
(circle one) 
CRIMINAL REGISTRATION SEX OFFENDER/PREDATOR CAREER OFFENDER 
REGISTRANT SIGNATURE 
DATE 
FINGERPRINT AIDE 
ELM 
DATE 
2s 
70a./A-Ais 
PROBATION OFFICER 
DATE 
Please be advised that the only location for registrations is at the Stockade 673 Fairgrounds Road West 
Palm Beach. Bonn are Monday to Friday Sam to 4pm (closed holidays). No one will be processed beyond 
4pm. Please bring proper ID and/or paperwork to assist us in registering you properly into the system. 
3228 Gun Club Road • West Palm Bead), Florida 31406-3001 • 
• httplAw.w.pbso.org 
aroma 
Meant 
and UdirpoPISCNCAlotme Sallvotr•mtctory 
FISCLKIC.• Otm 
EFTA00182082

Offender Name:  , E R.F 12...E1/41  C.:PM i 
DC#: 
CONDITIONS OF SUPERVISION You must obey all conditions of supervision. If you do not obey one or more of your conditions of 
supervision, your probation officer will report this to the cowl or Florida Parole Commission. You may be arrested for disobeying (violating) your 
conditions of supervision. 
OFFENDER COMPLAINT (GRIEVANCE) PROCESS 
If you have a complaint (grievance) about your officer or the Department of Corrections, you need to report this within 10 days. Please use the 
following steps to report your complaint: 
1. 
First, talk to your probation officer about your complaint to see if you can work out a solution. 
-If you ere not satisfied wilt
 ciffioawirespohne tb yolk complaint, talk to -the afters-supervisor. If you are nor satisfied with• the -- --
supervisor's response to your complaint, you may write your complaint on a piece of paper and give it to the officer's supervisor. The 
supervisor will said you a response to your written complaint. 
3. 
If you are not satisfied with the supervisor's response, you may send your written complaint to the Circuit Administrator, who is in charge of the 
circuit You need to also attach a copy of the complaint letter you sent to the supervisor, along with the supervisor's response The Circuit 
Administrator will review your complaint and send a response to you. 
4. 
If you are not satisfied with the Circuit Administrator's response, you may send your written complaint to the Regional Director for review. 
You also need to attach a copy of the complaint letter you sent to the supervisor, the supervisor's response, a copy of the letter you sent to the 
circuit administrator, and the circuit administrator's response The Regional Director will review your complaint and send you a written 
response. 
5. 
if you are not satisfied with the Regional Director's response, you may send a written complaint to the Assistant Secretary of Community 
Corrections for review. You also need to attach a copy of the complaint letter you sent to the supervisor, the supervisor's response, a copy of 
the letter you sent to the circuit administrator, the circuit administrator's response, a copy of the letter you sent to the regional director, and the 
regional director's response The Assistant Secretary of Community Corrections will send you a written response 
6. 
Complaints (grievances) must be written neatly and must include your complete name, your Department of Corrections (DC) number, your 
signature, and the date you signed the grievance Your complaint letter must clearly state what the complaint is about 
Please note that complaints about violations must be discussed with your attorney, the judge, or the Florida Parole Commission — not the probation 
officer. If your complaint has anything to do with your health or a disability, please send your complaint letter straight to the Assistant Secreary of 
Community Corrections instead of going through the other steps 
IMERGENCY CONTACT 
Probation offices are open Monday 
m gam to 5pm. If you need to contact your officer due to an emergency outside of these hours, 
all the following telephone n 
Discuss all regular business with your officer during the week when the office is open. Please 
do not call the emergency number 
-ida% amen 
on is a true emergency and whatever you need to toll your officer cannot wait until the probation 
office is open. If your emergency is a life-threatening situation, always contact your local police, fire or medical emergency personnel before you 
call your probation officer. 
FIREARMS. WEAPONS. AND EX-PLOSIVES 
State and Federal laws do not allow anyone on supervision to possess, purchase, receive, or transport firearms, weapons, or explosives. 
rmIMINAL REGISTRATION (Applies to all offenders with felony offense° 
Section 775.13, Florida Statutes requires you to register with the sheriff of any county you arta in Florida, within-48 hopes. The sheriff's office 
may require you to be fingerprinted and photographed. If you do not go to the theirs aloe as required, you maybe charged with a misdemeanor 
of the second degree. Sex offenders or career offenders who are required to register, may be charged with a second or third degree felony. 
DRUG TESTING 
1. 
As a condition of supervision, you may be drug tested by a probation officer at any time.. 
2. If you do not cooperate with the officer conducting the drug teat, or tamper with the dog test sample, or test positive for alcohol or other thugs, 
your probation officer will report this as a violation to the court or Florida Parole Commission. 
3. If your chug test is positive, the judge or the Florida Parole Commission may modify or terminate your supervision. They may add conditions of 
supervision orient:ewe you to a more intensive type of supervision, jail, or prison. 
4. 
You must pay for drug testing fees, as instructed by your probation officer. 
EMPLOYER NOTIFICATION 
Due to the Department of Corrections' having authority to make rules according to Section 944.09, Florida Statutes and the Department of 
Corrections Rule 33-302.10Z your employer must be aware that you are on supervision with the Department of Conte-Sons. Your employe: must 
also 'mow the details of your offense and sentence Your officer will notify your employer of this information now and throughout the course of your 
supervision. 
DC3-246 Front (Revised 2/8/08) 
Section 6 — Offender File 
EFTA00182083

the crimes they have committed. 
I have been given a more complete explanati 
"this statute and understand that I must let the Depart 
of Corrections know if I have had, have, 
or we thinking about having any involvement in a book, written article, video, movie or other account of is.e crime(s) for which I was convicted. 
NOTIFICATION OF RESTORATION OF CIVIL RIGHTS asvin PROCESS 
The following is provided as tiery basic information regarding the restoration of civil rights review process. For more complete information 
regarding civil rights restoration, pardons, or eligibility requirements, contact the Office of Executive Clemency, 
• 
• 
inator, Office of 
Executive Clemency, 2601 Blair Stone Road, Building sC", Room 229, Tallahassee, Florida 32399-2450 or call 
Information can 
also be accessed through the following web site: lutpdapoiatelluguneumaiu 
Restoration of Civil Rights In Florida 
- -The restoralion-ofcivii rights restores-to an individual the right to bold public office, to serve on ajury, to hold certain professional-liana& and the 
right to vote in the State of Florida. It does not restore the specific authority to own, possess, or use firearms. Such restoration shall not relieve an 
individual from the registration and notification requirements or any other obligations and restrictions imposed by law upon sexual predators or 
. 
- sexual offenders. 
. 
 
.
ludfiteamikulha,101 am
...
 es
Firearms
The specific authority to own, possess, or use firearms in Florida can only be restored by the Board of Executive Clammy. This authority is not 
automatic. There is an eight (8) year waiting period from the date supervision terminates or the sentence expires before application can be made, 
Applications can be obtained from the Office of Executive Clemency or be accessed by the following web site httpr//fprestateffus/Clemencv hon. 
Restoration of Civil Rights or Allen Status Under Florida Law 
A person may not apply for the restoration of ha/his civil rights unless s/he has completed all sentences imposed and ail conditions of supervision 
have expired or been completed, including, but not limited to, parole, probatico, community control, control release, and conditional release. If the 
peace was convicted in a court other than a court of the State of Florida, Ole must be a legal resident of the State of Florida at the time the 
application is filed, considered, and acted upon. If the person is applying for Restoration of Alien Status Under Florida Law, s/he must be domiciled 
in the State of Florida at the time the application is filed, considered, and acted upon 
Review Proceu 
For persons terminating supervision or being released from incarceration who are eligible for restoration of civil rights or alien status larder Florida 
Law, the Department of Corrections forwards a monthly computer generated epplication of individuals released from incarceration or discharged 
from supervision to the Florida Parole Commission. The Florida Parole Commission reviews records of individuals released from expiration of 
sentence or discharge from supervision. If the individual meet; the eligibility requirements and does not receive more than the requisite number of 
objections from the Board of Executive Clemency, the Office of Executive Clemency mails a certificate evidencing the restoration of civil rights or 
alien status to the individual's last 3010W12 address, usually within one (I) year from the date of expiration of sentence or &theme from supervision. 
If the individual does not meet the eligibility requirements, the office of Executive Clemency notifies the individual by mall that s/he is not eligible 
for restoration of civil rights witho 
• 
hearing by contacting the Office of Executive Clemency at the mailing address, 
telephone number, email address 
, or the website address provided. Until an individual has received final 
notification by the Office of Executive 
emency on 
e app cation for restoration of civil rights, she le responsible for providing the Office 
of Executive Clemency with his/her most current address for contact purposes. If en individual is in need of a certificate within an earlier time 
cane, or has any questions on eligibility requirements, s/he may contact the Office of Executive Clemency directly at any time. 
I hereby certify that I have received a copy of the Department of Corrections Instructions to Offender and understand if I have any questions 
regarding this incarnation Ian to ask my prole 
fficer to explain further. . 
Officer's Signature 
Date 
DC3-246 Back (Revised 2/8/08) 
Section 6— Offender File 
EFTA00182084

FLORIDA DEPARTMENT OF CORRECTIONS 
CONSENT AND AUTHORIZAnON FOR USE AND DISCLOSURE It4RPECTION AND RELEASE 
CONFIDENTIAL INFORMATION 
 
 authorize 
 
(Name, organization or genall decapitate of program making dithlosure) 
to disclose to 
(Name of person(s) or wpm:ideas) to rakh disclosure is to be made) 
Purpose of disclosure authorized herein: 
The undersigned beiebY lutheeizeithe inspection and release &copies of my medical :tads indicited below by die eliot o-'tiarctedlieeh6 
care facility/medical record custodian cnly to the above-named catitvlies) or persons or their agents. Indicate all of the records authorized 
io be inspectedIrelessed by initiating in the appropriate box(es) below: 
FOR MUSE Of 
INFORMATION 
A. 
Release of all medical records moo: any information relating to HIV testing, AIDS and AIDS-related 
syndromes; psychiatric and psychological information; or alcohol and substance abuse treatment information 
related to my condition, care, and confinement (Inlets! box). 
B. 
Release of any records regarding HIV testing, AIDS and AIDS•related syndrome relating to my condition, 
are, and confinement (Initial box). 
C. 
Release of any records of psychiatric and psychological information (mental health records) other than 
psychotherapy notes relating to my conditions, are, and confinement (initial box). 
D. 
Release of all dental records relating to my condition, are and confinement (initial box). 
E 
Release of any records regarding alcohol and substance abuse (merman relating to my condition, care, and 
confinement 
1 understand that my meads are protected under the federal regulations governing 
Confidentiality of Alcohol and Drug Abuse Patient Records. 42 U.S.C. §290 (eeX2), and cannot be disclosed 
without my written consent artless otherwise provided for in the regulations. 
As to release of 
alcoholisubnance abuse treatment records, please state the specific information to be released as provided by 
42 U.S.C. §290 (eeX2), Fed rule 42 CFR Part 2 (tattled box): 
Name of information —dotes of treatmempognims, etc, if possible 
NOTE: IF PSYCHOTHERAPY OR SUBSTANCE ABUSE PROGRESS NOTES ARE THE SUBJECT 
OF THE RELEASE, OTHER RECORDS CANNOT BE THE SUBJECT OF TIE SAME 
AUTHORIZATION. 
RELEASE OF PSYCHOTHERAPY OR SUBSTANCE ABUSE PROGRESS 
NOTES IN ADDITION TO THE RECORDS SPECIFIED ABOVE WILL REQUIRE A SEPARATE 
AUTHORIZATION (SEE BELOW). 
understand that I may revoke this assent and authorization at any time, provided the revocation is in Aram except to the extent that 
action has been taken in reliance on it, and that in any event, this consent and authorization shall be effective for 90 days unless I specify a 
different expiration as follows:  
(Specification of the date, went, or condition upon which this comma expires if less than A months or greater tin 90days) 
In furtherance of this authorization, I (we) do hereby waive all provisions of law and privileges relating to the disclosures hereby 
authorized. I acknowledge the extent of my authorization of release as to the records and information denoted in paragraphs A, B, C, D 
and E by Initialing the appropriate box(es) above. 
SIGNATURE OF PATIENT IGuiple or Sucatoriy Authrzed Rey-ma-min, them spin* 
Dee 
AUTHORIZATION FOR RELEASE OF nYCHOTHERAPHY OR SUBSTANCE ABUSE PROGRESS NOTES 
 
, authorize 
(Name, organization or general designation of program maims disclosure) 
DC4-711B (English) (Revised 2/06) 
EFTA00182085

r wawa PrarAll 1 
1 WC .,'Jams:.....,..., 
CONSENT AND AUTHORIZATION FOR USE AND DISCLOSURE INSPECTION AND RELEASE 
CONFIDENTIAL INFORMATION 
to disclose to 
(Warne of person(*) or orpnuation(s) to Much duckpins ism be made) 
Purpose of disclosure authorized herein: 
The undersigned hereby authorizes the inspection and release of copies of my psychotherapy progress notes and/or my substance abuse 
progress notes as indicated below by the above-named health care facility/medical record custodian only to the above-named eatitv(ies) or 
persons or their agents. Indicate all of the records authorized to be inspected/released by initialing in the appropriate box(es) below 
INITIAL RELOW 
FOR RELEASE OF 
INFORMATION 
A. 
Release psychotherapy prowess notes (Initial box): 
B. 
Release substance abuse progress notes (Initial box): 
Name of information — dues of creatmeattirogratan ere, if Passible 
I understand that I may revoke this consent and authorization at any time, provided the revocation is in writing, except to the extent that 
action has been taken in reliance on it, and that in any event, this consent and authorization shall be effective for 90 days unless I specify a 
different expiration as follows:  
(SpeaSestion of the date, event, ee condition upon which this cement expires if leas than six meths or gnaw than 90 days) 
In furtherance of this authorization, I (we) do hereby waive all provisions of law and privileges relating to the disclosures hereby 
authorized. I acknowledge the extent of my authorization of release as to the records and information denoted in paragraphs A and B 
initialing the appropriate box(es) above. 
SIGNATURE OF PATIENT er men enc.. ante ermeourd tupprereno.inee mined) 
Date 
COMPLETE NOTARY PORTION ONLY WHEN REQUEST IS NOT FROM CURRENT INMATE/OFFENDER PERSONALLY KNOWN 
TO WITNESS OR IS FROM SOURCE EXTERNAL TO DEPARTMENT 
STATE OF 
COUNTY OF 
Swan to (or affirmed) and subscribed bereft me this day of 
20 
by 
 
 
who 
is 
personally 
known 
to 
me 
or 
who 
has 
produced 
 
as identification: 
Notary Public Signature 
Print. type, or stamp commissioned name of Notary Public 
My Commission Expires: 
SEAL 
ACKNOWLEDGEMENT OF RECEIPT OF COPY OF SIGNED AUTHORIZATION(S1 
Inmate/Offender Name 
 
Witness Name 
DC# 
Witness Signature 
R/S 
Date: 
Date of Birth 
SSrl  
Institution/Office 
DC4-7118 (English) (Revised 2106) 
EFTA00182086