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.~ <br />c <br />Card No. <br />DELINQUENT ACCOUNTS WORK SHEET <br />~~-13-00 ISQFI.Da ! <br />z Agency 7 s Type v t o Account Number x t zx <br />TB <br /> ~ <br />C (1 O <br />C <br />za Balance Due zs <br />~ <br />ao Date Last as ae Adjustmentaz <br />~ I 1 I I <br /> m TI Statement To Balance ~'-~err <br /> ~o~ir~cz (`fro 111 1no T ~~ I <br />z 2 ~ <br />, <br />ra Debtor's Name IL~st, Flrtt) sl sx Recipient of Service If Different <br />3 I "L! y Jr ~ l-Lt'~ ~ Y~ l n e ~rR.V~ ~1 dYl~ I ~ <br /> 9 zra Address Llne One sl sz Address Line Two ~ <br />eot <br /> I I'l <br />~ <br />~p Q ~ ~ O (f' ~'~CR~O I I LI ~-~-Q - `1 ~l '-~ ~o I <br />4 4 t <br />, <br />z~ City, State ~~ <br />~7 ~s Zip sz sa Telephone s9 fio Area Coda fiz <br /> Applicable <br />Il <br />6 f3 L _ _~ I I I I I I I I~ ~ I I <br />~ l <br /> <br />f Sua~~.~. ~~GuC~rl Nuug6L y~ <br />~t en.c of 6~9-TM yl~ fi] f l f~ <br />l <br />69 Cr 70 ~ <br />71 77 <br /> Amt. Comm. Status Assignment or <br /> Adjustment Disp. Transfer Code <br />~ ~ za Employer sl sx Reference s <br />e a ~~ r~ <br />I (cz-~ m~a r L n~ I I I Sc A,r.~ +r~ I <br /> r <br />z~ Reference sl sz Reference ao <br />9~ <br />A <br />Fa <br />9' <br />x s Nota for Next Monthly Collections Report <br />Ar xa PS zfi z7 CBR an 71 DMVR as ~s AC ae <br />Forme qt;-76-ot ~ <br />Line 9 and A is for Central Collection Use Only <br />