| STATEMENT OF PAYMENTS RECEIVED FOR THE PERIOD ENDING MM/DD/YY | ||||||||||||
| CAPITAL COLLECTION SERVICE | ||||||||||||
| P.O. BOX 151 | ||||||||||||
| WEST BERLIN NJ 08092 | ||||||||||||
| 609-768-4225 | ||||||||||||
| CLIENT NAME | ||||||||||||
| ADDRESS | ||||||||||||
| CITY/STATE/ZIP | ||||||||||||
| DEBTOR NAME | DEBTOR | CLAIM DT | CODE | PD AGCY | PD YOU | AGCY FEE | CL BAL | |||||
| AQUILLA | VIOLET | 090286997 | 8/18/04 | 01 | 40.00 | 14.00 | 219.32 | |||||
| BARTEE | MILDRED | 096786900 | 1/19/05 | 01 | 11.82 | 4.14 | 185.00 | |||||
| BONSAL | DONNA | 084255898 | 2/24/05 | 01 | 30.00 | 10.50 | 55.63 | |||||
| CHAMBERLAIN | SHIRLEY | 080410558 | 2/24/05 | 01 | 30.00 | 10.50 | 52.36 | |||||
| FERRESE | RANDY | 0762699499 | 7/13/04 | 01 | 25.63 | 8.97 | PIF | |||||
| FORMAN | CHARLENE | 104849012 | 6/14/04 | 11 | 253.62 | 88.77* | PIF | |||||
| HARVEY III | AARON | 075506794 | 7/13/04 | 01 | 25.00 | 8.75 | 352.68 | |||||
| REED | LINDA | 254872599 | 5/22/04 | 11 | 111.52 | 39.03 | PIF | |||||
| *=LAW PYMT | ||||||||||||
| PAYMENT SUMMARY | ||||||||||||
| TOTAL PAID TO AGENCY | 162.45 | TOTAL PAID TO YOU | 365.14 | |||||||||
| TOTAL COLLECTED FOR MONTH | 527.59 | TOTAL AGENCY FEES | 184.66 | |||||||||
| WE OWE YOU | 162.45 | ENCLOSED FIND CHECK# | ||||||||||
| YOU OWE US | 122.45 | PLEASE SEND CHECK | ||||||||||
| PAYMENT CODES: 51=CLIENT PAYMENT 21/31=NSF CHECKS PIF=ZERO BALANCE 02=LEGAL/FWD | ||||||||||||