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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

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?

3. Please confirm date detention began:

4. Please confirm earliest release date:

Signature;

Full name:

Status: __

Prison stamp:

delete as applicable

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