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:t ~ <br />Card No. <br />DELINQUENT ACCOUNTS WORK SHEET <br />~~-13-~~ ~_.~ 1 ~P~LI~~ 1 H <br />s Agency r e Type 9 to Account Number zt 2z <br />TB <br />~ ~~~-3-~ ^T-y-tC~ za Balance Dua z9 ao Data Last as as Adjustment+z I I <br />T"' ~ / Statement To Balance ~`~°err <br />n ~ - -_ <br />2 rl ~, _~...~ ,~~ <br />:a Debtor's Name Last, Flrstl st sz <br />9 I 3 ~ ~ 0 ~` ~0.C'C,l.l r~~Q ~ Y ~ ~ I <br />ra Address Li One -~ sz <br />Address Line Two <br />4 1 Sece.:~,1 I t' _ uX~Y~ I n~~ox. j 't 0 0 ~ `[ 3~ - l ~E7~ I ~ b (o <br />za City, Stale es~ ~e Zip sz sa Telephone s9 so Atea Code sz <br />I ~'' II '' If Applicable <br />g a~ _~ ~ I I I I I I I f~ f~ f~ <br />SJGr~y. JEL49.•ry Ju v.gBt 4~ Hi ~~.c of B~LTH 4V 6a 69 Cr 70 7I )a <br />Amt. Comm. Statut Assignment or <br />Adjustment Disp. 7ranster Coda <br />~ I ~ <br />za Employer sr sz Relerence e <br />xa Reference ss ~ sz Relerence eo <br />9a <br />za Note for NaKt Monthly Collections Report eo <br />A• zs CS ze ar CBR ~n st DMVR a. ns AC ae <br />Forma AC 46.0 <br />• Line 9 and A is for Central Collection Uss Only <br />