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Your Company Name Here

411 Walnut Street


Green Cove Springs, FL 32043
1-866-327-0035 x309

INVOICE

Bill To: Mr Dennis Ferguson Invoice Date: 05-23-2016


Dept of Children & Families Invoice Number: 116
5775 Osceola Trail
Naples Invoice Period: 05-01-16 - 05-31-16
FL 34109

Phone: (239) 377-0001


Fax: (239) 377-0336 Vendor Number: V-CODE-001
Thank You! PO Number: PO:4587

DESCRIPTION DATE AMOUNT

Tutoring Services 05-01-16 - 05-31-16 $1,800.00

TOTAL $1,800.00

TOTAL HOURS TYPE RATE


36 LA:27:00 MA:9:00 50.000
36

Students Served: 4

Please remit payment to:


Your Company Name Here
411 Walnut Street
Green Cove Springs, FL 32043
1-866-327-0035 x309

Provider Signature:________________________
Name: Kath Thoresen

(* = Invoice limited by PPA)

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NAMENAME SCHOOL
SCHOOL GRADE
GRADE ID ID DATE
DATE HR:MIN
HR:MIN TOTAL
TOTAL$$ TUTOR
TUTOR Session
Session
Type
Type
Dewar, Mandy Avalon Elementary 4 8787656952 05-03-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-03-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-03-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-03-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-05-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-05-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-05-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-05-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-10-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-10-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-10-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-10-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-12-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-12-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-12-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-12-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-17-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-17-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-17-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-17-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-19-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-19-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-19-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-19-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-24-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-24-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-24-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-24-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-26-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-26-16 1:00 50.00 Alice Bright Small Group
School M456

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NAMENAME SCHOOL
SCHOOL GRADE
GRADE ID ID DATE
DATE HR:MIN
HR:MIN TOTAL
TOTAL$$ TUTOR
TUTOR Session
Session
Type
Type
Fahali, Fatima Avalon Elementary 2 8787656820 05-26-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-26-16 1:00 50.00 Alice Bright Small Group
School M456
Dewar, Mandy Avalon Elementary 4 8787656952 05-31-16 1:00 50.00 Alice Bright Small Group
School M456
Doyle, Yvonne Avalon Elementary 4 123454 05-31-16 1:00 50.00 Alice Bright Small Group
School M456
Fahali, Fatima Avalon Elementary 2 8787656820 05-31-16 1:00 50.00 Alice Bright Small Group
School M456
Thompson, Jamal Avalon Elementary 4 id31#1 05-31-16 1:00 50.00 Alice Bright Small Group
School M456

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