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STATE OF FLORIDA FLORIDA ELECTIONS COMMISSION In Re: Thaddeus Thad Hamilton TO: Thaddeus Thad Hamilton P 0 .. Box 26653 I amaiac, FL 33320 Case No.: FEC 14-438 Division of Elections 500 S B10nough Street, Room 316 I allahassee, FL 32399 NOTICE OF HEARING (AUTOMATIC FINE) A hearing will be held in this case before the Florida Elections Commission on February 25, 2015, at 1:00 pm, or as soon theteafter as the parties can be hemd, at the following location: Senate Oflice Building, Room 110-S, 404 South Monroe Street, Tallahassee, FL 32399. Failure to appear in accordance with this notice will constitute a waiver of your right to participate in the hearing Continuances will be granted only upon a showing of good cause This hearing will be conducted pursuant to Section 106.25, Florida Statutes, which governs your participation as follows: If you are the Respondent, you may attend the hearing, and you or your attorney will have 5 minutes to present your case to the Commission However, some cases (including those in which consent orders or recommendations for no probable cause are being considered) may be decided by an en masse vote and, unless you request to be heard or the Commission requests that your case be considered separately on the day of the hearing, your case will not be individually heard If you are the Complainant, you may attend the hearing, but you will not be permitted to address the Commission In addition, some cases (including those in which consent orders or recommendations for no probable cause are being considered) may be decided by an en masse vote and, unless the Respondent requests to be heard or the Commission requests that the case be considered separately on the day of the hearing, the case will not be individually heard If you are an Appellant, and you have requested a hearing, you may attend the hearing, and you or your attorney will have 5 minutes to present your case to the Commission Please be advised that both confidential and public cases are scheduled to be heard by the Florida Elections Commission on this date. As an Appellant, Respondent or Complainant in one case, you will not be permitted to attend the hearings on other confidential cases The Commission will electronically record the meeting Although the Commission's recording is considered the official record of the hearing, the Respondent may provide, at his own expense, a certified court reporter to also record the hearing If you require an accommodation due to a disability, contact Donna Ann Malphurs at (850) 922-4539 or by mail at I 07 West Gaines Street, The Collins Building, Suite 224, Tallahassee, Florida 32399, at least 5 days before the hearing. See forthcr instructions on the reverse side. NOH FEC #14-438 jlmy :Md(eever 'loman Executive Director Florida Elections Commission Febrnary 9, 2015

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  • STATE OF FLORIDA FLORIDA ELECTIONS COMMISSION

    In Re: Thaddeus Thad Hamilton

    TO: Thaddeus Thad Hamilton P 0 .. Box 26653 I amaiac, FL 33320

    Case No.: FEC 14-438

    Division of Elections 500 S B10nough Street, Room 316 I allahassee, FL 32399

    NOTICE OF HEARING (AUTOMATIC FINE)

    A hearing will be held in this case before the Florida Elections Commission on February 25, 2015, at 1:00 pm, or as soon theteafter as the parties can be hemd, at the following location: Senate Oflice Building, Room 110-S, 404 South Monroe Street, Tallahassee, FL 32399.

    Failure to appear in accordance with this notice will constitute a waiver of your right to participate in the hearing Continuances will be granted only upon a showing of good cause

    This hearing will be conducted pursuant to Section 106.25, Florida Statutes, which governs your participation as follows:

    If you are the Respondent, you may attend the hearing, and you or your attorney will have 5 minutes to present your case to the Commission However, some cases (including those in which consent orders or recommendations for no probable cause are being considered) may be decided by an en masse vote and, unless you request to be heard or the Commission requests that your case be considered separately on the day of the hearing, your case will not be individually heard

    If you are the Complainant, you may attend the hearing, but you will not be permitted to address the Commission In addition, some cases (including those in which consent orders or recommendations for no probable cause are being considered) may be decided by an en masse vote and, unless the Respondent requests to be heard or the Commission requests that the case be considered separately on the day of the hearing, the case will not be individually heard

    If you are an Appellant, and you have requested a hearing, you may attend the hearing, and you or your attorney will have 5 minutes to present your case to the Commission

    Please be advised that both confidential and public cases are scheduled to be heard by the Florida Elections Commission on this date. As an Appellant, Respondent or Complainant in one case, you will not be permitted to attend the hearings on other confidential cases

    The Commission will electronically record the meeting Although the Commission's recording is considered the official record of the hearing, the Respondent may provide, at his own expense, a certified court reporter to also record the hearing

    If you require an accommodation due to a disability, contact Donna Ann Malphurs at (850) 922-4539 or by mail at I 07 West Gaines Street, The Collins Building, Suite 224, Tallahassee, Florida 32399, at least 5 days before the hearing.

    See forthcr instructions on the reverse side.

    NOH FEC #14-438

    jlmy :Md(eever 'loman Executive Director Florida Elections Commission Febrnary 9, 2015

  • Please refor to the information below for fu1ther instrnctions related to your paiticulai hearing:

    If this is a heaiing to consider an appeal from an automatic fine, the Filing Officer has imposed a fine on you for your failure to file a cainpaign treasurer's report on the designated due date and, by filing an appeal, you have asked the Commission to conside1 either (I) that the repo1t was in fact timely filed; or (2) that the1e were unusual circumstances that excused the fail me to file the repmt timely. You aie 1equired to prove your case If the Commission finds that the repo1t was filed timely or that there were unusual circumstances that excused the failure, it may waive the fine, in whole 01 in pa1t The Commission may reduce a fine after consideiing the facto1s in Section 106 265, Florida Statutes If the Commission finds that the report was not timely filed and there we1e no unusual ci1cumstances, the fine will be upheld

    If this is a hearing to conside1 a consent order before a determination of probable cause has been made, the Commission will decide whether to accept or reject the consent order. If the Commission accepts the consent order, the case will be closed and become public.. If the Commission 1ejects the consent 01de1 01 does not make a decision to accept or deny the consent order, the case will remain confidential, unless confidentiality has been waived.

    If this is a hearing to consider a consent order after a determination of probable cause has been made, the Commission will decide whether to accept or reject the consent orde1 If the Commission accepts the consent orde1, the case will be closed If the Commission rejects the consent order 01 does not make a decision to accept 01 deny the consent mder, the Respondent will be entitled to another heaiing to dete1mine if the Respondent committed the violation(s) alleged

    If this is a probable cause hearing, the Commission will decide if the1e is probable cause to believe that the Respondent committed a violation of Florida's election laws.. Respondent should be prepaied to explain how the staff in its 1ecommendation incorrectly applied the law to the facts of the case Respondent may not testi.fY, call others to testifj;, or introduce any documentary or other evidence at the probable cause hearing The Commission will only decide whether Respondent should be charged with a violation and, before the Commission determines whether a violation has occuned or a fine should be imposed, Respondent will have an opportunity for anothe1 hearing at which evidence may be introduced

    If this is an informal hearing, it will be conducted pmsuant Sections 120.569 and 120.57(2), Fl01ida Statutes; Chapter 28 and Commission Rule 2B-1004, F101ida Administrative Code At the heaiing, the Commission will decide whether the Respondent committed the violation(s) chaiged in the Orde1 of Probable Cause The Respondent will be permitted to testify However the Respondent may not call witnesses to testify

    Respondent may argue why the established facts in the Staff Recommendation do not suppmt the violations chaiged in the Order of Probable Cause At Respondent's 1equest, the Commission may determine whether Respondent's actions in the case were willfol The Respondent may also address the appropriateness of the 1ecommended fine If Respondent claims that his limited resomces make him unable to pay the statutory fine, he must provide the Commission with written proof of his financial resources at the hearing A financial affidavit form is available from the Commission Cle1k

  • FLORIDA ELECTIONS COMMISSION CASE REPORT

    Case Number: FEC-14-438

    NAME: THADDEUS THAD HAMILTON

    DAIEAPPEALRECEIVED: 11/19114

    DAIE HEARING REQUESI RECEIVED: NIA

    DAIE REPORI DUE: 10/25/14 (2014 DI)

    DAIE OF ELECTRONIC RECEIPI: 10/27 /14

    DAIE FILING OFFICER RECEIVED REPORI: 10/27 /! 4

    NUMBEROFDAYSLA1E: 2

    AMOUNI OF FINE: $100.00

    FINE BASED ON: (X) NUMBER OF DAYS ( .. ) 25% OF RECEIPTS ( •• ) 25% OF EXPENDITURES

    Tor AL RECEIPTS FOR REPORIING PERIOD: $1, 155 .. 00

    TOTAL EXPENDIIURES FOR REPORIING PERIOD: $0

    DAIE OF FIRS I NOIIFICA IION: 11/3114

    SUMMARY: Thaddeus Thad Hamilton is a candidate for Commissioner of Agriculture in the 2014 elections Karen L Hamilton is his treasurer

    Thaddeus Hamilton is appealing the fine claiming that his wife, the campaign treasurer, had major surgery on July 1, 2014. According to Mr. Hamilton, after spending 9 days in the hospital, his wife also was on bed rest for two weeks. He spent most of his time with her and neither of them realized that the report was due ..

    • The 2014 DI Report covers the period from 10/18/14-10/24/14; it was due on 10/24/14 • The 2014 DI Queued Transaction Report reflects that this report was filed on 10/27114, amended on

    11110/14 and 11/12/14. • Mr Hamilton reported receiving 7 contributions, while making 0 expenditures. • The history notes from the division do not list anything pertaining to the 2014 DI reporting period

    **I conducted a telephone interview with Mr. Hamilton on 1/12/15 .. I asked him if he could provide any medical documents for his wife's surgery and he stated that he would fax it over in the morning (Tuesday 1/13/15). *please see attached medical information

    PRIOR CASES: 14-270 was heard at the 2014 October meeting The fine was $308 . .75 and was upheld.

  • /

    \.

    LTC. Thaddeus "Thad" Hamilton, US Army, Retired For Florida Commissioner of Agriculture and Consumer Services

    POBox26653

    .January 13, 2015

    Ms .. Braxetor1 Wins Fax; SS0-921 ·-0783

    Tamarac, FL 33320 {954) 547-9115

    thadcampaig')[email protected] Website: Voteforthad201.4.com

    From: Thaddeus Hamilton

    Phone: 850-922-4539 Ext. 109

    Please let me know if you need any more information.

    Thaddeus Thad Hamilton

    Poiitlca! adve(ti:llrig p

  • ( )OeT 2~ 2014 .. 1:;9~66/'S'I"'., .,3,SG.>"'N.::io,, ~IS~7.,'Z07 P '!

    / 1,

    HCA Healthcare '.'

    Aoeounnuel ADMISSION DATE: O 7 101 /14

    lNDIC:AI!ONS:

    PREOPf.RA!IVE DIAGNOS.rs:

    P0510Pf,Rl!T IVE DIAGNOSB.S;

    ..

    PROCED!JRE:

    ,to, 10= 11

  • FROM

    I

    SURGEON:

    ~nuel Porth, flD

    ASS ISTllNT:

    Elisa Strennen i.s a physician assistant.

    ESTIMATED BLOOD LO.SS:

    ..

    DESCRIPTION OE PROCl?.D!IRF!:

    t}ie

    PATIENZ NAME.:· J:l.AMILION,MREN ACCOUNl #'

    t 90

    ~t!.d 12

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    y

    1''1Plt.i:c·r

    D: 07/Ql/2014 10:43:42 T: 07/01/2014 14.:14:43 Conf#1DJD#: 2 lrnthent:icQtd by Manu€7 Porth MD On 07/0812014 12:02:42 PM

    - ---···--·-·--. --·-··- -- ------- -- ·-.. ··~--· -·------·---

    Mintiel Porth,

    Dict.Rted By:

    .r.nnuel Porth,

  • PATIENT Ni\11£' !l?!J

  • PATIEN1 NAJ''1£; HAMILTON,l

  • I

    / I

    STATE WIDE, On Nov.4, 2014 Vote For LTC. Thaddeus "Thad" Hamiltpn, US Army, Retired ' For Florida Commissioner of Agriculture and Consumer Services

    PO Box :Z6653

    November 19, 2014

    Kristi Reid Bronson

    Tamarac, FL 33320 (954) 54'7-9115

    [email protected] Website: Voteforthad2014 .. com

    Chief, Bureau of Election Records 500 South Bronough St Tallahassee, Fl 32399

    Re: CAN campaign treasurer's report due October 25, 2014,,

    I am requesting a waiver of the fine on campaign treasurer's report due October 25, 2014 due to: On July 1, 2014 Karen Hamilton, rny wife and campaign treasurer, had a major surgery and spent 9 days in the hospital .. Up on being discharge from the hospital she was confined to the bed for two weeks. Because Karen is still recovering from the

    operation, Karen nor I realized that the report time frame had changed frorn 7 days to l day I am requesting a waiver of the fine on campaign treasurer's report due July 11, 2014 Thank You for your help

    ~a&«J_.) /1!&1-lfct··~~) Thaddeus Thad liamiiton, Candidate for Florida Commissioner of Agriculture and Consumer Services

    Dlc:!

  • FLORIDA DEPARTMENT OF STATE Ken Detzner

    November.3, 2014

    Thaddeus Thad Hamilton

    Candidate for Commissioner of Agriculture

    9352 Northwest 46 Court Sunrise, FL 33351-3351

    Re: CAN 60304

    Dear Mr Hamilton:

    Secretary of State

    DIVISION OF ELECTIONS

    The campaign treasurer's report that was due October 25, 2014, was not filed until October 27, 2014. Accordingly, you are fined in the amount of$100.00 The fine must be paid to the Division of Elections within 20 days of receipt of this notice unless appealed to the Florida Elections Commission Please note that as a candidate, the fine is not an allowable campaign expenditure and must be paid from personal funds

    !fyou wish to appeal the fine, you must submit a notice of appeal to the Commission within 20 days of the date of the receipt of this notice .. (See Rules 2B·· 1 005 and 2B-· l .0055, Florida Administrative Code.) The Florida Elections Commission's address is 107 West Gaines Slleet, Suite 224, Tallahassee, Florida 32399-0100.

    Please send a copy of your notice of appeal to the Bureau of Election Records at the address listed below .. If you have any questions, please contact us at (850) 245--6240

    Sincerely, ..---····-

    +:~ ~ ~....._,._;., ~ _ _,_:c_.( . Kristi Reid Bronson, Chief Bureau of Election Records

    cc: Karen L. Hamilton, Treasurer

    "The RA Gray Building-Room 316 • 500 South Bronaugh Street • Tallahassee FL 32399-0250 • (850) 245-6240 ---·----·---FAX:-(850)-245-6260-•-WWW-Address:.http:lli

  • 111212015 Filed Camaign Treasurer's Report Page 1

    Thaddeus Thad Hamilton Elect ID: 20141104-GEN From: 10/18/201 Amd:Y Wvr:N Filed: FIL 10127/2014 10:23:15

    60304-AGR Report: 2014 01 (30) To: 10/24/201 Cmplt: COM Reviewed: AUD 11/12/2014 1:04:58 P

    Original Report Submitted: 10127/2014 10:23:15

    CONTRIBUTIONS Seq Contributor Occupation Errors

    Date Name Address Type Inkind Descnptton An1d Amount

    BENFORD 1967 IMPEREAL GULF COURSE RD. I 0 $10.00

    10118/2014 TAMYA NAPLES FL 34110 CAS

    2 GARGON 149 FOREST HILLS BLVD. I RETIRED 0 $25.00

    10118/2014 GARY NAPLES FL 34113 CHE

    ~ GARGON 149 FOREST HILLS BLVD. I RETIRED 0 $25.00

    10118/2014 MICKEY NAPLES FL 34110 CHE

    4 CHEW 626 3RD. ST I 0 $5.00

    10118/2014 BELLLYE NAPLES FL 34102 CAS

    s CHUMBLELY 4033 STOW WAY RETIRED 0 $40.00 10118/2014 ERIKCA NAPLES FL 34116 CHE

    6 SHEILAH 2743 BUCKTHORN WAY ' RETIRED 0 $1,000.00 10/19/2014 CROWLEY NAPLES FL 34105 CHE

    7 MITCHELL 10829 CAMINO CIR. ' MINISTRY 0 $50.00 10/19/2014 VINCENT WILLINGTON FL 33414 CHE

    r->,.

  • 1/12/2015

    Thaddeus Thad Hamilton

    60304-AGR

    EXPENDITURES Seq Date Ntlme

    HAMILTON

    10/2112014 THADDEUS

    2 WALMART

    10/21/2014

    3 TACO BELL

    1012112014

    4 OAKLAND PARK BP

    10/2212014

    5 AMSCOT FINANCIAL SERVICES

    10/21/2014

    6 LANIER PARKING SOLUTIONS

    10/22/2014

    7 7ELEVEN

    10/2112014

    8 OAKLAND PARK BP

    10121/2014

    9 BROWN

    10/23/2014 ED RENA

    10

    II BROWN

    10/17/2014 EDRENA

    Filed Camaign Treasurer's Report Elect ID: 20141104-GEN

    Report: 2014 01 (30)

    From: 10/18/201

    To: 10/24/201

    Amd: Y

    Cmplt: COM

    Amended Report

    Office Address Type Purpose

    9352 NW 4TH CT. PCW

    SUNRISE FL 33351 PETIYCASH

    3306 N UNIVERSITY DR. PCS

    SUNRISE FL 33351 SUPPLIES

    7625 W COMMERCIAL BLVD. PCS

    TAMAR.AC FL 33351 FOOD FOR VOLUNTEERS

    2091 W. OAKLANDPARKBLVD PCS

    OAKLAND PARK FL 33311 GAS

    205 COMMERCIAL BLVD. PCS

    TAMAR.AC FL 33319 STAMPS

    421 SE2NDST PCS

    FT LAUDER.DAL FL 33301 PARKING

    9390 W COMMERCIONAL BLVD. PCS

    SUNRISE FL 33351 GAS

    2091 W OAKLAND PARK BLVD. PCS

    OAKLAND PARK FL 33311 GAS

    PO BOX 100646 RMB

    FT. LAUDERDAL FL 33310 GAYLENNWARDEN LABOR

    x

    PO BOX 100646 RMB

    FT. LAUDERDAL FL 33310 RENT AL CAR REB!RSEMENT

    Page2

    Wvr:N Filed: FIL 1012712014 10:23:15

    Reviewed: AUD 11/12/2014 1:04:58 P

    Submitted: 11/1012014 10:05:23

    Errors

    Antd Amount

    0 $200.00

    ADD

    0 $21.61

    ADD

    0 $5.50

    ADD

    0 $15.00

    ADD

    0 $2.45

    ADD

    0 $6.00

    ADD

    0 $50.04

    ADD

    0 $15.00

    ADD

    ' $400.00 ADD

    8 $0.00

    ADD

    2 $300.00

    ADD

  • 1112/2015

    Thaddeus Thad Hamilton

    60304-AGR

    EXPENDITURES Seq Date Nflme

    9 BROWN

    10123/2014 ED RENA

    IO

    II BROWN

    10/17/2014 ED RENA

    OTHER DISTRIBUTIONS Seq Date Na1ne

    WARDEN

    10/23/2014 GAYNELL

    2 BROWN

    10/23/2014 ED RENA

    Filed Camaign Treasurer's Report Elect!D: 20141104-GEN

    Report: 2014 01 (30)

    From: 10/18/201 Amd:Y

    To: 10/24/201 Cmplt: COM

    Amended Report

    Office Address Type Purpose

    PO BOX 100646 RMB

    FT. LAUDERDAL FL 33310 GAYLENNWARDEN LABOR

    x

    PO BOX 100646 RMB

    FT. LAUDERDAL FL 33310 RENTAL CAR REBIRSEMENT

    Rec1p1ent Office Address Type Purpose

    236 SE 9111 A VE. APT. 1 0

    POMPANO BEAC FL 333060 RMB LABOR

    PO BOX 10064 0

    FT_ LAUDERDAL FL 33310 RMB LABOR

    Page3

    Wvr:N Filed: FIL 1012712014 1023:15

    Reviewed: AUD 1111212014 1:04:58 P

    Submitted: 11112120141:05:25 p

    Errors

    Antd Amount

    0 $400.00

    UPD

    8 $0.00 _,,.---

    DEL

    2 $300.00

    DEL

    Errors

    Amd Amount

    0 $375.00

    ADD

    0 $25.00

    ADD

  • 1/12/2015

    Thaddeus Thad Hamilton

    60304-AGR

    Filed Camaign Treasurer's Report Page4

    Elect ID: 20141104-GEN

    Report: 2014 01 (30)

    From: 10/18/201 Amd: Y Wvr: N Filed: FIL 10127/2014 10:23:15

    To: 10/24/201 Cmplt: COM Reviewed: AUD 1111212014 1:04:58 P

  • 1/12/2Q15 Queued Items for 2014-01 Page 1

    Account: 60304 AGR Thaddeus Thad Hamilton Rpt Seq: 30

    ProcessDesc1iption Status Submitter Created Last Update

    Create Pending Report Processing Complete 60304 10/27/2014 9:08:32 AM 10/27/2014 9:08:32 AM

    File Pending Report Processing Complete 60304 10/27/2014 10:23:15 AM 10/27/2014 10:23:15 AM

    Review Filed Report Processing Complete ejrowlette 10/28/2014 4:49:38 PM 10/28/2014 4:49:38 PM

    Amend Filed Report Processing Complete 60304 11/10/201410:01:28 AM 11/10/2014 10:01:28 AM

    File Pending Report Processing Complete 60304 11/10/2014 10:05:23 PM 11/10/2014 10:05:23 PM

    Amend Filed Report Processing Complete 60304 11/12/2014 12:32:02 PM 11/12/2014 12:32:02 PM

    Review Pending Report Processing Complete 60304 11/12/2014 12:58:31 PM 11/12/2014 12:58:31 PM

    Review Pending Report Processing Complete 60304 ll/12/20141:04:58PM 11/12/2014 1:04:58 PM

    File Pending Report Processing Complete 60304 11/12/2014 1 :05:25 PM 11/12/2014 1:05:26 PM

    ··----~---·--·-----------·--------- .. ---- - ------------- ----------------~--- -- ---~ _,,~------------.----.. ·----------------------------~~--------- ---·-------.-----

  • FEC - Candidate/Committee Filir · Bisto1y Report

    search J directory 1 contact us 14111 subscribe I tour 1 help

    Florida Department of State - Division of Elections Florida Election System Reports

    Candidate/Committee Lookup

    Name: !Hamilton ' ~·-----.-------- ,_ ____ ., -

    Election:

    '-~---··-········-·· ..... J~I Acct: 1~()~0~ i

    Type: !candidate ---····J~]'. ,------.-~-

    1 ··"Reset I i Search

    Candidate Name: Thaddeus Thad Hamilton Account: 60304

    Date Due Type Date Filed Status

    1111412014 LR 1111012014 1013112014 G7 111112014 SNT 1013012014 06 1013012014 1012912014 05 1012912014 1012812014 04 1012812014

    1012712014 03 1012712014

    10/26/2014 02 10/2712014 CLO

    10/25/2014 01 10/2712014 APP 10/24/2014 G6 10/2412014 10117/2014 G5 10/1712014

    10/10/2014 G4 10/1012014 1013/2014 G3 10/212014

    912612014 G2A 912412014 911912014 G2 911812014 911212014 G1A 911212014 91512014 G1 914/2014

    812912014 P7 A 812912014 812212014 P7 812212014 811512014 P6 811512014

    81812014 P5 817/2014 81112014 P4 713112014 712512014 P3 712412014 711812014 P2A 711812014

    711112014 P2 711812014

    71412014 P1A 713/2014 612712014 P1 612612014 611012014 M5 611012014 511212014 M4 511212014

    411012014 M3 411012014

    311012014 M2 311012014 211012014 M1 211012014

    111012014 M12 11912014 12110/2013 M11 1211012013 1111212013 M10 1111212013 1011012013 Q3 1011012013 711012013 Q2 71912013 411012013 Q1 41812013

    CLO

    Days Fine Late Assessed

    $250 00

    $000

    2 $100 00

    7 $308.75

    Page 1 of I

    Appealed Amount Amount

    Fined Paid

    $250 00 $0 00

    $0 00 $0 00 $100 00 $0 00

    $308 75 $308 75

  • PHONE LOG Case No.: 14-438

    Respondent: Thaddeus Thad Hamilton

    L Date and time: 1112/15 Name: Thaddeus Thad Hamilton Phone#: 954-547-9115 Summary: I spoke with Mr.. Hamilton regarding his appeal and asked him if he could provide documents for his wife's surgery.. He stated that he would fax the information to me in the morning I gave him my direct extension and told him to call me if he had any twuble sending it over .. Entered by: BWims

    2 Date and time: Name: Phone#: Summary: Entered by:

    3.. Date and time: Name: Phone#: Summary: Enternd by

    4 Date and time: Name: Phone#: Summary: Entered by:

    5. Date and time: Name: Phone#: Summary: Entered by:

    6.. Date and time: Name: Phone#: Summary: Entered by:

    7 Date and time: Name:

    ·----------Ffl003·(3/09)-----··----···- - · --·--··-·-·---·

    Case Summary ReportPatient notesAppeal noticeFine notice2014 D1 reportQueued items for 2014 D1 Filing historyPhone log