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Owner' s Name: SANDBERG, DOROTRY <br /> Facility Name & Addre,, Account Ma_ u�ng Address <br /> LINDEN MEDICAL CENTER TNC <br /> <br /> <br /> Name <br /> Care Of <br /> Street Number Street <br /> City State _ Zip - <br /> Phone _-_- Alternate _-_- Alternate #2 - - <br /> Census District Location _ City code <br /> Balances - <br /> 1 to 30 $ 0. 00 <br /> 31 to 60 $ 0 . 00 Last payment $ 340 . 00 <br /> 61 to 90 $ 0 . 00 Promised Amount <br /> 91 to 120 S 0. 00 Sent to collections <br /> 121 Plus $ 0 . 00 <br /> Total Due $ 0 . 00 Prior month' s balance S 0 . 00 <br /> Processing Page 1 <br /> F ACCTREC Accounts Receivable <br /> Account ID 0003562 Facility ID 003951 Cross-Ref <br /> Responsible party <br /> Name <br /> Care Of <br /> Street Number Street <br /> City State _ Zip - <br /> Phone _-_- Alternate _-_- Alternate #2 _-_- <br /> Census District Location _ City code <br /> Balances - <br /> 1 to 30 $ 0. 00 <br /> 31 to 60 $ 0 . 00 Last payment $ 340 . 00 <br /> 61 to 90 S 0 . 00 Promised Amount <br /> 91 to 120 $ 0 . 00 Sent to collections <br /> 121 Plus S 0 . 00 <br /> Total Due S 0 . 00 Prior month' s balance $ 0 .00 <br /> F=Find E=Enter U=Update D=Delete Page 1 2 :43 : 37p <br /> Account ID: 0003562 <br /> Date P/E Description Type Receipt # Check # Amount <br /> Invoice #017118 $ 0 . 00 <br /> 01/11/95 2380 UST BEFORE 1/84 170 . 00 <br /> 01/11/95 2380 UST BEFORE 1/84 170 . 00 <br /> 03/15/95 9994 Penalty 340 .00 <br /> 03/14/95 9999 PAYMENT Check 95 PER 894 170.00 <br /> 03/14/95 9999 PAYMENT Check 95 PER 894 170 . 00 <br /> 03/15/95 9997 CORRECTION TO A CHARGE 340 . 00 <br /> Invoice #006828 $ 0 . 00 <br /> 04/30/92 9950 PRIOR BALr'RtE r 1564 . 00 <br /> 09/30/93 9999 PAYMENT Cash back fees Coll 1564 .00 <br />