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to -
`
`Jody Phillips
`Clerk of the Circuit Courts
`Jacksonville, Florida
`Payment Authorization
`
`Take this form to the cashier designated by the clerk
`No personal checks accepted - Please read instructions on the back.
`
`Division:
`
`CR-D
`
`Pay at Room: 2136
`
`Offender No:=2023-015803 *See Reverse Side for Payment Information
`
`Bond No:
`Bond Amount:
`
`Case No:
`
`16-2023-CF-007076-AXXX-MA
`
`Citation Number:
`
`Court Date:
`
`7/25/2023 9:00:00AM
`
`Case Name:
`
`DAVIS, KENYON DARRELL
`
`Court Room:
`
`306
`
`Locations:
`
`3rd Floor
`
`WARNING: Failure to pay fines, penalties, and/or costs by the Due Date mayresult in this case being referred to collections with
`a 40% increase addedto the total cost.
`In addition a drivers license suspension mayresult.
`(See reverse side for collections example.)
`
`Fine $50.00
`
`Case Type: CF
` Fines, Penalties and/or Cost Imposed
`
`
`
`LEEA
`Cost With
`Type Charge
`ae a 5% CVC
`aanSOULKOSSooTOe]
`PO
`2Yessssssmeia
`
`
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`
`
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`
`
`7[sees|||++idd
`
`
`
`0[
`
`a B
`
`alance Due:
`
`Bond Forfeited:
`
`Pay Out of Bond:
`
`Refund:
`
`Court Attorney $
`
`Probation Fees $
`Restitution $
`RCC $
`ClerksFee$
`**Monthly PartialPayment**_
`
`
`leo|ssooofc,fs PartPmtreefs
`
`
`
`
`juorr|seso0aac.|se500[srs
`
`
`
`
`
`pare [es—foocin |emmyfe
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`
`
`
`ES7
`
`
`
`possIs,TroyfsAum_/Date Prepared:
`
`
`Clerk's Signature:
`
`__FEB212024
`
`07/02/2023
`
`

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