Case Number: 94D 00098
File Date: 07-18-1994
ST OF KANSAS, EX REL SRS
Address:
DOB:
Attorney:
GUILLEN, LUIS
Address:
WAMEGO KS 66547
DOB:
Attorney:
| Receipt Number | Receipt Date | Payor Name | Total Amount |
|---|---|---|---|
| 9662 | 08/10/1994 | WHITE,S/GALLAS & SCHULTZ | 75.00 |
| 9683 | 08/11/1994 | GUILLEN,L/MCCALL PATTERNS | 69.28 |
| 10225 | 09/15/1994 | ADJUSTMENT | -75.00 |
| 10227 | 09/15/1994 | ADJUSTMENT | -69.28 |
| 10229 | 09/15/1994 | GUILLEN,S (ADJ #10225) | 75.00 |
| 10230 | 09/15/1994 | GUILLEN, LUIS | 0.00 |
| 10232 | 09/15/1994 | GUILLEN, L (ADJ #10227) | 69.28 |
| 10233 | 09/15/1994 | GUILLEN, LUIS | 0.00 |
| Description | Transation Date | Amount Paid | Payor |
|---|---|---|---|
| C/S #8158 | 08/10/1994 | 75.00 | WHITE,S/GALLAS & SCHULTZ |
| C/S #17270 | 08/11/1994 | 69.28 | GUILLEN,L/MCCALL PATTERNS |
| C/S REFUND (8-10-94) | 09/15/1994 | -75.00 | GUILLEN, LUIS |
| ADJUST SRS | 09/15/1994 | 0.00 | GUILLEN, LUIS |
| C/S REFUND (8-11-94) | 09/15/1994 | -69.28 | GUILLEN, LUIS |
| ADJUST SRS | 09/15/1994 | 0.00 | GUILLEN, LUIS |
| ADJ #10225 TO WR PMT | 09/15/1994 | 75.00 | GUILLEN,S (ADJ #10225) |
| ADJ #10225 TO WR PMT | 09/15/1994 | -75.00 | GUILLEN, LUIS |
| ADJUST SRS | 09/15/1994 | 0.00 | GUILLEN, LUIS |
| ADJ #10227 TO WR PMT | 09/15/1994 | 69.28 | GUILLEN, L (ADJ #10227) |
| ADJ #10227 TO WR PMT | 09/15/1994 | -69.28 | GUILLEN, LUIS |
| ADJUST SRS | 09/15/1994 | 0.00 | GUILLEN, LUIS |