| Type of Incident: | Team |
| Match Number: | |
| Date of Incident: | 2012-12-09 |
| Time of Incident: | 12:35:00 |
| Location of Incident: | Phone |
| Competition: | 2012_SOR_FALL_ |
| Home Team: | Atlas Academy Merced |
| Visiting Team: | Ajax United Football Club |
| Age Group and Gender: | U11B |
| Team Affiliation of Individual Committing Incident: | Forfeit by visiting team |
| Incident Summary: | Ajax forfeited 2 hours before match |
| Comments: | PAD Ruling:
1) Game is ruled a forfeit win for Atlas Merced
2) Ajax is required to reimburse Atlas Merced the 80$ for field and referee fees
3) Fees should be paid by January 10 |
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