ATLANTA POLICE DEPARTMENT

DECISION TO IMPOSE MONETARY FINE

EMPLOYEE NAME (LAST, FIRST, MI)	4 DIGIT ID NO	OPS CONTROL #
An investigation was conducted where evidence was gathered to sustain a violation of
employee work rule	entitled:

City Code 98-26 authorizes the Chief of Police to administer monetary fines not to exceed $500.00.

The City or Department property that was damaged or lost is described as:

The cost to replace/repair that property has been determined to be:

A monetary fine will be imposed in the amount of:

A monetary will not be imposed

CHIEF of POLICE SIGNATURE
DATE

The fine must be paid by payroll deduction. You can pay the monetary fine in full, or you can have a minimum of $20.00 deducted from each paycheck until the fine is paid in full. Unless you specify otherwise, the Department will deduct the full amount of the fine from your next paycheck.

I authorize the Department to deduct the fine, by payroll deduction, in full.

I authorize the Department to deduct from each paycheck until the fine is paid, in full.
EMPLOYEE SIGNATURE
DATE

Form APD-849

ATLANTA POLICE DEPARTMENT

KCJackson

2005-03-25

AJordan

APD