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Account number: 55508596

Re: Mr Simon Cordell DOB: 26/1/81

Prison number: WF6739 Please

write in black ink.

1. I certify that the claimant named above *is / is not* currently

detained in this establishment (and eligible to be disregarded) for
the purpose of the Local Government Finance Act 1992.

2. Is the above named serving a sentence for non-payment of a fine,
Community Charge or Council Tax?

*YES / NO*

3. Please confirm date detention began: / /

4. Please confirm earliest release date: / /

Signature: __________________________

Full name: __________________________

Status: _____________________________

Prison stamp:

* delete as applicable

X:\DRG4CON.d0t

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