TRAVIS COUNTY COMMUNITY SUPERVISON PROGRAM TRAVIS COUNTY DOMESTIC RELATIONS DIVISION 1010 LAVACA, P.O. BOX 1495 AUSTIN, TEXAS 78767 PHONE: (512) 854-9696 FAX: (512) 854-9819 PROBATIONER’S MONTHLY REPORT DRO ACCOUNT NUMBER:__________________________ OR OAG ACCOUNT NUMBER: _____________________________ E-MAIL ADDRESS: ____________________________________________ NAME: _____________________________________________________ HOME PHONE NUMBER: ________________________ SOCIAL SECURITY NUMBER:______________________________ CELL PHONE NUMBER: ___________________________ HOME ADDRESS: ___________________________________________________________________________________________ WITH WHOM ARE YOU LIVING WITH/RELATIONSHIP: _________________________________________________________ EMPLOYER NAME: _______________________________________ EMPLOYER PHONE NUMBER: ______________________ EMPLOYER ADDRESS: ______________________________________________________________________________________ TYPE OF WORK: ________________________ DOES EMPLOYER KNOW YOU ARE ON PROBATION? CIRCLE: YES OR NO DO YOU WORK DAYS: _____ EVENINGS: _____ NIGHTS: _____ HOURS YOU WORK: ______________ TO _____________ IF EMPLOYMENT HAS CHANGED SINCE LAST REPORT, LIST NEW EMPLOYER’S NAME, ADDRESS, AND PHONE NUMBER: __________________________________________________________________________________________________ NET INCOME LAST MONTH $ ___________________ ARE CHILD SUPPORT PAYMENTS BEING DEDUCTED BY INCOME WITHOLDING? CIRCLE: YES OR NO DATE OF LAST CHILD SUPPORT PAYMENT PAID: _______________________________ AMOUNT: $ __________________ DO YOU OWN OR DIRVE A VEHICLE? CIRCLE: YES OR NO: MAKE: __________ MODEL: _________ YEAR: ___________ COLOR: __________ OWNER: _____________________________________________ LICENSE PLATE NUMBER: __________ STATE: ___________ DRIVER’S LICENSE AND/OR ID NUMBER: _______________________ HAVE YOU BEEN ARRESTED SINCE LAST REPORT? CIRCLE: YES OR NO. IF SO, EXPLAIN. USE BACK OF MONTHLY REPORT IF NECESSARY._____________________________________________________________________________________ ____________________________________________________________________________________________________________ AMOUNT OF PROBATION FEE PAYMENT SENT WITH REPORT: $ _____________ LIST ANY QUESTIONS AND/OR PROBLEMS YOU WISH TO DISCUSS WITH PROBATION OFFICER. USE BACK OF MONTHLY REPORT IF NECESSARY: __________________________________________________________________________ ____________________________________________________________________________________________________________ IF UNEMPLOYED, HOW LONG? __________ LIST LOCATIONS AND PHONE NUMBERS WHERE YOU HAVE LOOKED FOR EMPLOYMENT. USE THE OTHER SIDE OF MONTHLY REPORT IF NECESSARY: ______________________________ ____________________________________________________________________________________________________________ IF COURT ORDERED, HAVE YOU ATTENDED COUNSELING, CHEMICAL DEPENDENCY COUNCELING, EDUCATIONAL PROGRAMS? IF SO, LIST LOCATIONS AND PHONE NUMBERS: USE BACK OF MONTHLY REPORT IF NECESSARY: _______________________________________________________________________________________________ HEREBY ACKNOWLEDGE AND CERTIFY THAT I HAVE ANSWERED ALL QUESTIONS ABOVE, AND THAT THE INFORMATION IS TRUE AND CORRECT SIGNATURE: ________________________________________________ DATE: ________________________________________ American LegalNet, Inc. www.USCourtForms.com