Case Number: 91D 00081
File Date: 8/22/1991
CSE RECEIVABLES
Address:
650 WEST
TOPEKA KS 66612
DOB:
Attorney:
CLARK, SHANNON D.
Address:
200 POPLAR
WINCHESTER KS 66097
DOB:
Attorney:
| Receipt Number | Receipt Date | Payor Name | Total Amount |
|---|---|---|---|
| 1470 | 1/21/1992 | CLARK, SHANNON D. | 0.00 |
| 1561 | 2/3/1992 | CLARK, SHANNON/JF CO HOSP | 0.00 |
| 3019 | 7/1/1992 | CLARK, SHANNON D/SETOFF | 0.00 |
| 7219 | 7/12/1993 | CLARK, SHANNON D./SETOFF | 0.00 |
| 8556 | 11/2/1993 | CLARK, SHANNON D./SETOFF | 0.00 |
| 13402 | 7/1/1994 | CLARK, SHANNON/SETOFF | 0.00 |
| 13534 | 7/5/1994 | CLARK, SHANNON D/SETOFF | 0.00 |
| 15601 | 9/7/1994 | CLARK, SHANNON/WENDLAND | 129.37 |
| 16888 | 10/13/1994 | ADJUSTMENT | -129.37 |
| 16891 | 10/13/1994 | ADJUSTMENT | 129.37 |
| Description | Transation Date | Amount Paid | Payor |
|---|---|---|---|
| JUDG #19162 STAMPED | 1/21/1992 | 30.01 | CLARK, SHANNON D. |
| C/S #19239 STAMPED | 2/3/1992 | 30.01 | CLARK, SHANNON/JF CO HOSP |
| ATT ST TX 6-1-92 | 7/1/1992 | 63.68 | CLARK, SHANNON D/SETOFF |
| ATT STATE TX 6-15-93 | 7/12/1993 | 18.00 | CLARK, SHANNON D./SETOFF |
| ATT UNEMPLOY10-15-93 | 11/2/1993 | 30.00 | CLARK, SHANNON D./SETOFF |
| FED TX 6-9-94 | 7/1/1994 | 1183.00 | CLARK, SHANNON/SETOFF |
| STATE TX 6-15-94 | 7/5/1994 | 82.93 | CLARK, SHANNON D/SETOFF |
| C/S JUDG #25723 | 9/7/1994 | 129.37 | CLARK, SHANNON/WENDLAND |
| TRANSFER FROM NONSRS | 10/13/1994 | -129.37 | CLARK, SHANNON D. |
| ADJUST NON-SRS | 10/13/1994 | 0.00 | CLARK, SHANNON D. |
| ADJUST SRS | 10/13/1994 | 0.00 | CLARK, SHANNON D. |
| TRANSFER TO SRS | 10/13/1994 | 129.37 | CLARK, SHANNON D. |