Case Number: 95D 00055
File Date: 04/11/1995
ST OF KS EX REL SRS
Address:
DOB:
Attorney:
BELL, JOYCE
Address:
DOB:
Attorney:
| Receipt Number | Receipt Date | Payor Name | Total Amount |
|---|---|---|---|
| 23032 | 10/23/1995 | BELL,J/VALLEY VISTA CTR | 12.50 |
| 23369 | 11/01/1995 | BELL,J/VALLEY VISTA G.S.C | 12.50 |
| 24037 | 11/21/1995 | BELL,J/VALLEY VISTA G.S.C | 12.50 |
| 24500 | 12/05/1995 | BELL,J/VALLEY VISTA G.S.C | 12.50 |
| 24775 | 12/13/1995 | BELL,J/VALLEY VISTA G.S.C | 12.50 |
| 25245 | 01/02/1996 | BELL,J/VALL VISTA G.S.CTR | 12.50 |
| 25709 | 01/12/1996 | BELL,J/VALLEY VISTA G.S.C | 12.50 |
| 26018 | 01/24/1996 | BELL,J, VALLEY VISTA | 12.50 |
| 30043 | 05/14/1996 | BELL,J/FEDERAL SETOFF | 0.00 |
| 30470 | 05/30/1996 | BELL,J/MIDW HEALTH SERV | 12.50 |
| Description | Transation Date | Amount Paid | Payor |
|---|---|---|---|
| C/S #5016 | 10/23/1995 | 12.50 | BELL,J/VALLEY VISTA CTR |
| C/S #5039 | 11/01/1995 | 12.50 | BELL,J/VALLEY VISTA G.S.C |
| C/S #5118 | 11/21/1995 | 12.50 | BELL,J/VALLEY VISTA G.S.C |
| C/S #5168 | 12/05/1995 | 12.50 | BELL,J/VALLEY VISTA G.S.C |
| C/S #5186 | 12/13/1995 | 12.50 | BELL,J/VALLEY VISTA G.S.C |
| C/S #5251 | 01/02/1996 | 12.50 | BELL,J/VALL VISTA G.S.CTR |
| C/S #5287 | 01/12/1996 | 12.50 | BELL,J/VALLEY VISTA G.S.C |
| C/S #5338 | 01/24/1996 | 12.50 | BELL,J, VALLEY VISTA |
| C/S-(5-8-96)-FEDERAL | 05/14/1996 | 835.60 | BELL,J/FEDERAL SETOFF |
| C/S #060697 | 05/30/1996 | 12.50 | BELL,J/MIDW HEALTH SERV |