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rd No. DIVISION OF ACCOUNTS ANb CONTROL <br />DELINQUENT ACCOUNTS WORK SHEET <br />3 i3 OD C~ C-031-81 p <br />x Agency 7 s ype s t o Account Number z s TB No J C- D~ ~- <br />i <br />~ 0 <br />I za Balanc <br />e Due ze ao Date Last as ae Adjul stnsant axl I Cr 1 <br />~ Statement To Balance <br />~ l ~~r 1 CCt <br />v~ ~LtD (`~ . <br />ZnC I L I <br />q , <br />, <br />. <br />1 za Debtor's Name ILa t, Firttl ss sx Recipient of Service II Different eo <br /> - ~r <br />Y ~ ~~I I I <br />3 . ~ <br />~ za Address Line One ss rx Address Line Two col <br /> <br />~~ ~ ~~~~ I ra (' <br />~ I is o I I <br />a , ~~ <br /> za City, State ~7 ae Zip s s~ Telephone sv so Area Cod• 6xl <br /> tl Applicable <br />i <br />I g• I_ I I I I I I I I I I IC J ~ I 1 <br />~ I I <br />~ az Date a7 ae Set Next as a. as ~e ar to •s ea se Cr I 7 <br />0 ~ bs~~a <br />~ Promised Action Date to 1st 2nd 3rd 4th 5th 6th Amt. Comm. Status Assignment or <br />' <br />i Letter Action Adjustment Disp. Transfer Code <br />i <br />~ <br /> <br />I to Date of Birth /Employer s t sz Reference ea <br />9 l <br />~ <br />i za ?i~+% " Reference st Isx Reference en <br />9' <br /> za Note for Neat Monthly Collections Report eo <br />~' A' za PS ze n CBA an at DMVR xa as AC as <br />r ~ ' <br />• <br />F~ym: <br />. AC~76~0• <br />• Line 6 ,9 and A is for Central Collection Use Only <br />