NOTES

FMAT

• Verified: ~ Name: ~ Email: ~ Phone: ~ Concern: cx LPN: ~ Resolution: ~ Amount Paid: ~ Payment Code: ~ Amount Reduced (If Any): ~ FTF Code (Above $200):

FAIR TRAVEL* ~ Name: ~ Concern: ~ Resolution: ~ Email: ~ Phone: ~ Toll Amount: ~ Trip Id: ~ Trip Date: ~ Signature Name:

 COURT ~ Verified: ~ Name: ~ Concern: ~ Email: ~ Phone: ~ Resolution: ~ Amount Paid: ~ Payment Code: ~ Summons ID: ~ Toll Amount: ~ Additional Fee: ~ Signature Name: