Parent Education
Summary Sheet
Make check payable to: ________________________________
Submit completed form to Pepper Flenner at WV Supreme Court of Appeals 1900 Kanawha Blvd. Building 1, Room E-100 Charleston, WV 25305 304-558-0145
FEIN / SSN _______________________
________________________________ ________________________________ ________________________________
Class Date
County
Fee
Mileage
Out of pocket
Total
Total Due
_______________________
Approved by Supreme Court: ______________________________________ Date: ________
SCA-FC-PE-604 Summary (12-06)