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ard No. DIYiSION OF ACCOUNTS ANb CONTROL <br />DELINQUENT ACCOUNTS WORK SHEET <br />x Agency z e Type s to Account Number xt xx '1 1/~ ~I ~i ~;~LI _ I ,GJ <br />TB Vl 1. <br /> OG <br />~130 aa <br />~ <br /> ~ . F- <br />- <br />F~ <br />` <br />' ~ f <br /> xa Galante Due zo , <br />ao Date Last as as Ad <br />ustsnant a: Cr <br /> Statement To Balance <br />~ ~~~r~ca v~ ~-~ ~5 4lhc I ~ i I <br />2 ., <br />j xa Debtor's Name IL st, First) s t ~z Recipient of Service II Different ao <br />I P.0 , ~x ~~ I I <br />3 <br />' <br />i za Address Line One st sx Address line Twa eon <br /> <br /> <br />I xa City, State ~r ~e Zip sx l <br />sa Telephone sv so a Code 6=I <br />Are <br />1 If Applicable <br />s• ~ I j I j j j I~ 1{~' <br />~ <br /> <br />3I <br />Date a7 <br />7a Set Next ~7 <br />~~~ ~S ~e tr ~e ~9 <br />6a I I <br />69 Cr 70 <br />rl ra <br />~ Promised Action Date to 1st 2nd 3rd 4th 5th 6th Amt. Comm. Statuf Afsignment or <br />' Lelter Action Adjustment Disp. Transfer Code <br />i <br />~ ~ <br />I <br />i ra Date al Birth /Employer s s sz Reference eo <br />xa wt+% Reference <br />st <br />sz <br />Reference <br />e <br />i <br />9' <br />~ za Note /or NeMt Monthly Collections Report <br />A' fa PS ze n CBR an ar DMVR as ~s AC to <br />Ferm: AC~1a~0~ <br />'Line 6 ,9 and A is for Central Collection Use Only <br />G <br /> <br />