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FBI VOL00009
EFTA00723455
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2006 CASES Deborah O. Day, Psy.D. LMHC/Licensed Psychologist CASE NAME DIVISION DEPO HEARING TRIAL COUNTY Gelaides v. Gelaides Family T Orange Hedges v. Hedges Family D Collier Lee v. Lee Family T Monroe In Re: B. B. Dependency T Lake State v. Roberge Criminal T Brevard Giles v. Carnes Family T Orange Moses v. Moses Family T Orange Hedges v. Hedges Family T Collier In Re: Baby Twins Civil T Duval State v. Aquierre Criminal D Seminole State v. Aguierre Criminal T Seminole Key v. Velosi Family T Monroe Geever v. Warner Family T Orange State v. Williams Dependency H Orange JQC v. John Sloop JQC T Seminole State v. Chestnut Dependency H Hardee Handley v. Handley Family D Palm Beach State v. Edwards Criminal S Seminole Harrison v. Canepa Family T Collier DOH v. Nether DOH D Orange Stauffer v. Stauffer Family H Osceola DOH v. Hether DOH H Orange Mull v. Mull Family D Triska v. Triska Family T Orange Michelle Delaney, as parent and natural guardian of Jane Doe, a minor v. Brightwood Manor, L.L.0 Civil D Orange State v. Aguierre Criminal Spencer Seminole Rothenberg v. Rothenberg Family D Orange EFTA00723475
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2005 CASES Deborah O. Day, Psy.D. LMHC/Licensed Psychologist CASE NAME DIVISION DEPO HEARING TRIAL COUNTY Long v. Long Family H Seminole State v. Amador Dependency T Dade Parnell v. Parnell Family T Orange Moore v. Moore Family T Pasco State v. Mackey Criminal S Orange D. Smith v. John Parker, MD, et.al. Civil D Seminole In the Interest of M.N.B. Dependency D Orange State v. Abbott Dependency D Franklin Fano v. Fano Family T Palm Beach Komanetsky v. Komanetsky Family T Seminole Tyler v. McMahon Family D Duvall In Re: B. L. Dependency H Polk Ferguson v. Ferguson Family H Orange Keeler v. Keeler Family T Lake State v. Mackey Criminal H Orange Tyler v. McMahon Family T Duvall State v. Neil Juvenile S Volusia Costello v. Costello Family D Palm Beach Rhyne v. Bank of America, et.al Civil D Orange In the interest of M.N.B Dependency H Orange State v. Morey-Rierson Dependency H Polk Butler v. Butler Family T Seminole Young v. Vance Family T Seminole Atorresagasti v. Frey Family T Seminole State v. Heathcock Juvenile T Seminole Bennett v. Bennett Family H Orange Key v. Key Family H Monroe Bennett v. Bennett Family T Orange In Re: K. H. Dependency T Brevard In Re: A. It. Criminal D Pasco Costello v. Costello ' Family T Palm Beach Elias v. Elias Family T Pasco Lipka/Froch v. Vijaykumar Bhujang, M.D. Civil D Orange McDonald v. Holtz Family T Orange Oliver v. Oliver Family D Nassau Perez v. Sherer Family T Hillsborough Burro v. Burno Family T Lake State v. Burkhardt Family T Lake Machuga v. Machuga Family T Orange State vs. Mackey Criminal H Orange EFTA00723476
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JQA vs. Todd JQA T Orange Lafay v. Lafay Family T Orange State v. Obenland Criminal T Orange Kelly v. Stokes Family T Orange Quets v. Needham Civil D Duval Small v. Small Family H Orange Llorca v. Llorca Family T Orange EFTA00723477
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2004 CASES Deborah O. Day, Psy.D. LMHC/Licensed Psychologist CASE NAME DIVISION DEPO BEARING TRIAL COUNTY State v. Henderson Criminal D Orange State v. Reavley Criminal H Osceola McCray v. McCray Family H Orange Carson v Adams Family H Volusia State v. Harris Criminal S Orange State v. Hargis Criminal S Seminole State v. Rivera Criminal H(Frye) Seminole Esaray v. Esaray Family H Lake Ful£ord v. City of Winter Park Civil T Orange Thompson v. Thompson Family T Orange King v. Orange County School Board Civil D Orange State v. Osborne Dependency H Polk State tr. Morey Dependency H(Frye) Polk State v. Morey Dependency T Polk State v. Hill Criminal S Seminole Lee v. Lee Family T Seminole Sommers v. Feibus Family T Palm Beach Morris v. Morris . Family ID Palm Beach Zausch v. Woodward Family H Indiana State v. Reavley Criminal S Osceola State v. McDonald Criminal D Orange Russell v. Russell Family T Palm Beach Siebold v. Siebold Family D Broward Siebold v. Siebold Family H Broward State v. Mackey Criminal S Orange In Re: Cuevas Dependency H Seminole Tolle v. Aquina-Garcia as the personal representative of the estate of Robert L. Civil T Orange Toll; Deceased State v. Dunford Criminal S Orange Stanton v. Stanton Family D Orange State v. Ford Criminal D Brevard EFTA00723478
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Kathleen McHugh, Ph.D. Licensed Psychologist EDUCATION Doctor of Philosophy in Clinical Psychology (APA Accredited) Marquette University, Milwaukee Wisconsin Degree Conferred: May 2004 Doctoral Dissertation: Goal Setting by Women in Battered Women's Shelters Master of Science in Clinical Psychology Marquette University, Milwaukee Wisconsin Degree Conferred: August 1994 Thesis: An Attempt to Predict Change in Mood in Response to Cognitive and Behavioral Inductions Bachelor of Arts In Psychology, Summa Cum Laude University of Central Florida, Orlando Florida Degree Conferred: August 1991 Psi Chi Professional Honor Society (Psychology) EMPLOYMENT 1/06-Present Licensed Psychologist, Psychological Affiliates, Inc., Winter Park, Florida. Providing individual therapy to children, adolescents, and adults. Presenting problems include divorce, relationship issues, domestic violence, body image, OCD, and a broad range of other anxiety and mood disorders. Providing psychological evaluations of children, adolescents, and adults for various presenting issues, such as physical, emotional, and sexual abuse, neglect, parenting ability, personal injury, and competency, as well as general diagnostic and forensic evaluations. Providing testimony as an Expert Witness in Orange, Seminole, and Volusia counties. Consulted with Orange and Osceola Child Protection Teams during multidisciplinary staffing of cases of child abuse (through April 2007). Coordinating practicum students. 1/05-1/06 Psychological Resident, Psychological Affiliates, Inc., Winter Park, Florida. Provided individual therapy to adolescents and adults. Presenting issues included divorce, child abuse, domestic violence, and a broad range of anxiety and mood disorders. Completed and assisted with evaluations of children, adolescents, and adults for various presenting issues such as EFTA00723479
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PAGE 2 OF 4 Employment-Continued physical, emotional, and sexual abuse, neglect, parenting ability, competency and sanity, custody, risk management, sexual offending and treatment planning. Consulted for Orange, Seminole and Osceola County Child Protection Teams during multidisciplinary staffing of cases of child abuse. Coordinated practicum students. 10/99-1/05 Juvenile Court Evaluator I, Brevard County Court Administration, Viera, Florida. Conducted mental health evaluations of children, adolescents, and adults as ordered by Juvenile Dependency and Juvenile Delinquency judges. Various presenting issues included: child abuse and neglect, substance abuse, domestic violence, antisocial behavior, and psychiatric conditions. Provided treatment recommendations for related professionals. 8/98-8/99 Clinical Psychology Intern, Aurora Mental Health Center, Aurora, Colorado. (APA Accredited). Conducted supervised individual, family, and group therapy with adults. Presenting issues included: child abuse and neglect, substance abuse, domestic violence, relationship issues, and various psychiatric conditions. Conducted supervised mental health evaluations on adults and children. Additional training in emergency mental health services, inpatient psychiatric treatment, day treatment programs for the seriously and persistently mentally ill, developmentally delayed adults, and emotionally impaired young children. Participated in and served as a therapist for Outward Bound programs for domestic violence survivors. 7/97-3/98 Family Therapist, St. Charles Youth and Family Services, Inc., Waukesha Wisconsin. Conducted individual and family therapy with adolescents referred by Juvenile Delinquency judges. OTHER PROFESSIONAL EXPERIENCE 8/92-6/98 Teaching Assistant (Marquette University), psychometrician (employed by private practice), graduate student instructor (University of Florida), graduate student facilitator at Center for Sexual Assault/Abuse Recovery and Education (University of Florida). PRESENTATIONS AND PUBLICATIONS 7/09 The Psychological Impact of Domestic Violence on Children of All Ages, presentation at the Florida Association of Community Corrections Statewide Conference. EFTA00723480
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PAGE 3 OF 4 3/09 The Psychological Impact of Domestic Violence on Children of All Ages, presentation at Domestic Violence/Dependency Training Event. 1/09 Children's Sexual Development, presentation for Training at Family Services of Metro Orlando. 8/05-12/06 Divided Loyalties: a psychoeducational program presented to separating, divorcing, and divorced parents. 8/05 Goal Setting by Women in Battered Women's Shelters, (author, dissertation), poster presented at the American Psychological Association Convention. 2001-2002 Domestic Violence: Effects on Adults and Children. Presentation to Brevard County Guardian Ad Litem Trainees quarterly. 1/98 An Attempt to Predict Change in Mood in Response to Cognitive and Behavioral Inductions, (first author), published in the journal of Psvchologv, vol. 132. 3/95 An Attempt to Predict Change in Mood in Response to Cognitive and Behavioral Inductions, (first author), poster presented at the Southeastern Psychological Association Convention. 11/94 A Comparison of Cognitive and Behavioral Mood Induction Techniques, (co-author), published in the Journal of Psycholokrv, vol. 128. 5/94 A Comparison of Cognitive and Behavioral Mood Induction Techniques, (co-author), poster presented at the Midwestern Psychological Association Convention. WORKSHOPS AND SEMINARS ATTENDED 12/09 Bridging the Gap: Improving Communication Between the Mental Health and Dependency Systems, Orlando, 6 hours. 10/08 The Lone Star Collaborative Law Training Workshop, Orlando, 16 hours. 9108 Positive Parenting With a Plan. Presented by Matthew Johnson, Psy.D., MSW, Orlando, 6 hours. 9/08 The Ten Best-Ever Anxiety Treatment Techniques. Presented by Margaret Wehrenberg, Psy.D., Orlando, 6 hours. EFTA00723481
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PAGE 4 OF 4 WORKSHOPS AND SEMINARS ATTENDED-Continued 3/08 Assessments in Contested Parenting Time and Access Matters. Presented by Marsha Hedrick, Ph.D., Jacksonville, 6.5 hours. 10/07 Florida Forensic Examiner Training. Presented by Randy K. Otto, Ph.D., and Chris Slobogin, JD, LLM, Ft. Lauderdale, 18.25 hours. 3/07 Play Therapy and Beyond: Treatment Techniques and Strategies with Children and Pre-Adolescents presented by Paul R. Whit; LCSW, Orlando, 6 hours. 10/05 9/05 7/03 2002 Forensic Evaluation and Juvenile Justice. Presented by Randy K. Otto, Ph.D., University of South Florida, 7 hours. Keeping Children Safe From Child Molesters. Presented by William Crew, M.A., University Behavioral Caner, 3 hours. Florida Crisis Response Team Advanced Training. Presented by Beth Rossman, FCRT, Inc. Chairperson, 16 hours. Florida Crisis Response Team Basic Training. Presented by Beth Rossman, FCRT, Inc. Chairperson, 40 hours. PROFESSIONAL AFFILIATIONS Member, American Psychological Association Member, Collaborative Family Law Group of Central Florida MEDIA PRESENTATIONS 12/09 Domestic Violence Channel 2 News 9/09 Child Abuse, Channel 2 News 8/09 Preparing Your Children For School, FOX News 35 4/09 Murder Suicide at Gun Range, Channel 6 News 2/09 Domestic Violence, Channel 6 News 2008 Where Is Cayleet Multiple appearances of FOX News 35 and Channel 9 News 7/07 Lindsey Lohan and Influence on Teens, FOX News 35 5/07 NBC's "iVillage Live' Sending Kids to College, Live from Universal Studios, Orlando, Florida 4/07 Privacy Issues and Mental Health, FOX News 35 4/07 Talking to Kids About T.V. Situations, Channel 6 News 4/07 Kids and Tantrums, FOX News 35 12/06 Women and Holiday Stress, FOX News 35 EFTA00723482
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2009 COURT CASES Kathleen McHugh, PhD. Licensed Psychologist CASE NAME DIVISION DEPO OR TRIAL COUNTY Miles/Qualheim Juvenile Dependency/Trial Seminole Butcher Criminal Competency/Hearing Seminole Franklin-White Criminal Sentencing Volusia Strike Family Hearing Orange EFTA00723483
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A AFFILIATES INC. PODHURST ORSECK ATTN: KATHERINE W. EZELL 25 WEST FLAGLER STREET,STE.800 MIAMI, FL 33130 Date Description BALANCE AS OF 05/ 01/ 2009 iI Provdet I Charges CieditS1 07/06/2009 CHARGE PATIENT -TC 30MIN-CONSULT AMY EDERLESO. I DAY I $162.60 07115/2009 CHARGE PATIENT • TC-1HR/ AMY EDERI. ESQ.-CONFERENCE CALL I DAY I $325.00 08/04/2009 PAYMENT PATIENT 179642 - cHEouti 08421/ ORESECK PA I DAY (6487.501 09/09/2009 CHARGE PATIENT • TM& 1 HR CONSULT/AMY EDERI ESO Ii MCHUGH I $275.00 10/20/ 2009 PAYMENT PATIENT 184355. CHECX# 109237 IMCHUGH (9275.001 10/26/2009 CHARGE PATIENT - TC30.0D/ AMY EDERI ESQ I DAY $162.50 10/28/2009 CHARGE PATIENT - TC30/ AMY EDERI ESO I MCHUG4 I $137.60 BALANCE AS OF 11/03/2009 I MCHUGH lle•Palfel••• wee. •nel •et••• l•••••••thle wait ••••••••••41 Statement printed for EPSTEIN, J • on - 11/03/2009 Aged Balances on Your Account Current 300.00 Client Amount Due: 300.00 0-30 days 0.00 Please Indicate amount Enclosed: 1) 30.60 days 60-90days 0.00 0.00 3 a Total Balance Due 300.00 TAX I.D # 59-2890080 PLEASE PAY PROMPTLY Payment is due upon receipt of bill Please make payment STATEMENT APPROVED FOR PAYMENT: ewe." te4 • DATE MATTER NO. VENDOR NO. EFTA00723484
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••••••••••••,%..1/4 D di U Ls_V PODHURST ORSECK ATTN: KATHERINE W. EZELL (Date 110/20/2009 iDethiption BALANCE AS OF 10/01/2009 Provider it Chaiges Payments 7 Credits lEalance $275.00! ,PAYMENT PATIENT 194305- CHECKS, 109237 MCHUGH ($275.00)! 50.001 110/26/2009 *CHARGE PATIENT - TC30-00/ AMY EDERI ESQ DAY 1 $162.50 1162.50$ 110/2612009 CHARGE PATIENT - TC30/ AMY EDERI ESQ MCHUGH 5137.50 $300.001 'BALANCE AS OF 10/27/2009 MCHUGH $300.001 rG sed Palen "mai Statement printed for EPSTEIN, J - on - 10/27/2009 Aged Balances on Your Account Current: 300.00 Client Amount Due: 300.00 Please Indicate amount Enclosed: 0-30 days 30-60 days 60.90 days Total Balance Due TM I.D # 59-2890080 PLEASE PAY PROMPTLY Payment is due upon receipt of bill Please make payment. o [Eig fl V/ fE 111 11 Nnv 9 zo39 Li By s„ismENIAPPg°vE 0,4E "" (0 0 mo-reg NO. NtEt,100a NO. 0,00 0.00 0.00 300.00 EFTA00723485
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PSYCHOLOGICAL S AFFILIATE INC. 111111.1r PODHURST ORSECK ATTN KATHERINE EZELL 25 WEST FLAGLER ST.,STE800 MIAMI, FL 33130 Data i Diner-anti:a ' I BALANCE AS OF 06/01/2009 !Pawl:ley I 09117/2009 !CHARGE PATIENT - TO8O-DDI AMY EDERI ESO i DAY I 09722/2009 I CHARGE PATIENT - MAILED OUT INVOICE I DAY I 09/23/2009 I CHARGE PATIENT -T000-0D/ AMY EDERI ESQ I DAY 0912412009 I CHARGE PATIENT • TC15-DD/ AMY EDRI ESQ DAY IBALANCE AS OF 10/01/2009 DAY t .N.":"ZP NO VMS, * NO t' • • 7 ,r71 • Charpes !Payments/ °sag I Boland. • I S325.00 " Awe ditoiricts325.00i n hie .1 us, S325.00! 5650.001 S0.00I 5731.251 9731.251 Liu t2 .1 A<fr\54/ "At re • ••••• •••• • •• 1•11••• LO•••• r•trie• vol ....... Statement printed for -on - 10/01/2009 Aged Balances on Your Account .......6.2r ---****--- Client Amount Due: 731 • V 0 _L I Please Indicate amount Enclosed: - TAX LD # 59-2890080 PLEASE PAY PROMPTLY Current Payment is due upon receipt of bill Please make payment 73125 0-30 days 0.00 30-60 days 60-90days 0.00 I;.;) Total Balance Due AC I0 Ye Alf -- 2 . %-------- EFTA00723486
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PSYCHOLOGICAL AFFILIATES INC. EM T PODHURST ORSECK ATTN: KATHERINE W. EZELL 25 WEST FLAGLER STREET,STE.800 MIAMI, FL 33130 °PROVED FOR PAYMENT: _ 0.1.1 E NO. VEt.tuIIR NO. 'Dere ! ! Ir. :LrescrctIon I BALANCE AS OF 06/01/2009 !Povider 1 I Coarges ;Paymants I Credtte! 1 i 07/08/2009 1CHARGE PATIENT - TC 30MIN-CONSULT AMY EDERLESO. 1 0-IARGE i DAY I 5162.501 1 107/15/2009 PATIENT • TC-1HR/ AMY EDERI, ESQ.-CONFERENCE CALL I DAY i 3325.001 OW0412009 ;PAYMENT PATIENT 179642- CHECK.#108421/ORESECK PA !DAY i i ($487.50)1 10W 09/2009 I CHARGE PATIENT - TC60/ 1 HR CONSULT/AMY EDERI ESO I MCHUG-I $275.001 I I ?BALANCE AS OF 10/01/2009 I oar-Huai r i i I i Client Amount Due: 275.00 Please Indicate amount Enclosed: 474fikilik l• • • • • MI6 6 • h• 61611 •• l• H•••• • •POS • Mil pppppp • Statement printed for EPSTEIN, J - on - 10/01/2009 Aged Balances on Your Account Current 275.00 0-30 days 0.00 30-60 days 0.00 60-90 days 0.00 Total Balance Due 275.00 TAX ID # 59-2890080 PLEASE PAY PROMPTLY Payment is due upon receipt of bill Please make payment EFTA00723487
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Sir PODHURST ORSECK ATTN KATHERINE EZELL 25 WEST FLAGLER ST.,STE800 MIAMI, FL 3313O 1, Date 109/17/2009 (Lb I Desn'Otbn IProvider Charges Payments / Oecets Balance BALANCE AS OF 09101009 I 1CHAROE PATIENT • TC8OOO/ AMY EDERI ESO DAY $325.00 S325.001 BALANCE AS OF 09222009 'DAY $325.001 'Dr Statement printed for - on - 09f22/2009 Aged Balances on Your Account Current: 325.00 Client Amount Due: 325.00 0.30 days 0.00 Please Indicate amount Enclosed: 30q .1'490 30-60 days 60-90 days 0.00 0.00 Total Balance Due 325.00 TAX ID # 59-2890080 PLEASE PAY PROMPTLY Payment is due upon receipt of bill Please make payment. .':'a MEET APPROVED FOR PAYMENT AfE Tiaq (109 RATTER NO g igiefil i t ° JENDOR NO EFTA00723488
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PODHURST ORSECK Cate IDesalpSs! . proider Charges ;Payments /Credit. &Nance tt i BALANCE AS OF 08/0112009 S0.001 09/17/2009 CHARGE PATIENT - TC30/ AMY EDERI ESO :MCHUGH $137.51 $137.501 BALANCE AS OF 09/17/2009 iMC,HUGH $137.50 caATEMENT APPROVED FOR PAYMENT: SY MATTER P10. VENDOR NO. Statement printed fo - on - 09/17/2009 Aged Balances on Your Account Current 137.50 Client Amount Due: 137.50 0-30 days 0.00 9- P 30-60 days 0.00 Please Indicate amount Enclosed: 13 60-90 days 0.00 Total Balance Due 137.50 TAX I.D # 59-2890080 PLEASE PAY PROMPTLY Payment Is due upon receipt of bill Please make payment. By ME 0 SEP 2 7. 2009 il EFTA00723489
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T PODHURST ORSECK ATTN: KATHERINE W. EZELL 25 WEST FLAGLER STREET,STE.800 MIAMI, FL 33130 ;Date 1 107/0812O09 107/15O009 .DescrtpUon BALANCE AS OF 07/01/2009 'CHARGE PATENT - TC 30MIN•CONSULT AMY EDERI,ESQ. 'CHARGE PATIENT - TC-1FIN AMY EDEN, ESQ.-CONFERENCE CALL 'BALANCE AS OF 071162009 487.50 Client Amount Due: 487.50 Please Indicate amount Enclosed: 'Previa (DAY ;DAY DAY Charges ;Pitmen% I Credits; $162.50 $325.00E Statement printed for EPSTEIN, J - on - 0711612009 I bged nelences on Your bcr.-co..mt Current 0-30 days 30-60 days 60-90 days Total Balance Due TAX I.D # 59-2890080 PLEASE PAY PROMPTLY Payment is due upon receipt of bill Please make payment. 0.00 0.00 0.00 487.50 l@III0Trz JUL 2 1 2BC3 EFTA00723490
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9126/2009 18:30 4077400902 n 26 09 06:23p Psychological Affiliates 4077400902 C (407) 740-6838 J D - PODEIURST ORESECK-KATHY EZELLESO. CITY NATIONAL BANK BUILDING 25 WEST FLAGLER ST.,STE.800 MIAMI, FL 33130 p.1 L/ its Desuipbon Provider °urges Pnyniets / Create Balance BALANCE AS OF 1/1/2009 $0.00 16/2009 •CKARGE PATIENT -PSYCHOLOGICAL EVALUATION DAY $3.0900(` $3.000.00 BALANCE AS OF 1/26/2009 DAY $3.030.00 3000.00 ant Amount Due: 3000.00 lase Indicate amount Enclosed: F1 -aa 11 3330S Statement printed for - on - 1/26/2009 Aged Balances on Your Account Current: 0.30 days 30-60 days 60-90 days Total Balance Due TAX It H 59.2890080 PLEASE PAY PROMPTLY Payment is due upon receipt of bill Please make payment. mENT APPROVED FOR PAYMENT: LA • C in NO. VE.t4D014 NO. 0.00 0.00 0.00 3000.00 EFTA00723491
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liaog ygor s-D 40/008 = * 40-`1, sm pt- 11O7 = /(crit EFTA00723492
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Psychological Affiliates, Inc. INVOICE Date 3/24/09 Ps cholo 'cal Affiliates Inc. To: Podhurst Orseck Attn: Katherine W. Ezell Ci National Bank Buildin Date Description Amount due 3/22/09-3/23/09 Mileage $179.85 3/22/09 Travel / full day $3,750.00 3/22/09 Dr. Day room $562.67 3/22/09 Dr. McHugh room $221.89 3/22/09-3/23/09 Food /Transportation $89.20 3/22/09 Interview room $386.70 3/23/09 Interview room $386.70 3/23/09 Travel/full day $3,750.00 Total $9,327.01 STATEMENT APPROVED FOR PAYMENT: BY DATE MAI i:;.. ts, VENDOR NO DESOIRAN 0. DAY, Nr.D. LICINstOPOISICLCOST LACDNID 140frAL Minn. COWMAN. Comma, TWIT MIM101 JACQUIIYN °LANDER, PND. ENDOW PDoctoottr C1130105 SOKOL Pacria.00ItT RouN Munc. PrtD. LamIlt4SDORLOCIO1 LIU/MO NNINA NAND* COuNILOR KAlitLVAN McHutai, uce Protta03461 MAMMA L KwN. Psr.D. LANDOW PINNO1.00in ALAN caveat, END. %least° RirciNtOCAD TAVAnsT ROIDAT )AletER, LianaD EsYclOOGAT mrugsA hmx. errs) LocuRSORESIOCIONST AMANDA K. buentR. POI) LaPAIDERICKROCan D TIB[EOTR MAR 3 0 2009 HONE elmlnal EFTA00723493
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Page No. I Guest Name: Deborah Day 2737 W Fairbanks Ave Winter Park, FL 32789 USA Room 3041 Folio'''. 828768 - 1 Group #: Guests: 1 Clerk: Arrive: 03/22/09 Time: 11:21 AM Depart 03/23/09 Time: 03:04:38 Stet FOL • Date 4'(*(crP0O1;/-±".?;, 01PP1 Pg4;ftVOttirg.1;:ei 03/16/09 DEP AMERICAN EXPREI 03168020 5005 109682 ($199.59) 03/22/09 ROOM SERVICE 7207 Charge Posting - TN: 7207 $80.57 03/22/09 I BAR 5035 Charge Posting - T#: 5035 S37.35 03522/09 CATERINGBANQ 1069 Charge Posting - TN: 1069 4326:60 03/22/09 IRONWOOD-D"4" 1 -- 3965 Charge Posting - TN: 3965 $222.86 03/22/09 PACKAGE BAR107 Pkg: Best Available Rate 1 2007 $179.00 03/22/09 PACKAGE TAX BARI07" Pkg: Best Available Rate 1 2007 $20.59 03/22/09 RESORT SERVICE FEE Recur 228 Recurring: Day 3041 $20.00 03/22/09 TAXES Recur 228t Recurring: Day 3041 $2.30 I agree that my liability for this bill is not waived and agree to be held personally liable in the event that the indicated person, complay, or association fails to pay for say part of the fall amount of those charges. I also agree that AU chirps contained la Ibis accent are correct and any disputes or requests for copies of charges most be made within fire days after my departure and I understand that late charges may be ended to my method of payment after my departure. I understand that I will be held liable sod personally responsible for any damage® made to the room and shall be notified within five days of my departure date and charged accordingly to repair the room to it, original condition. Signature. We invite you to use our comment card to give us your feedback on our enviromental program. EFTA00723494