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cJ Page' 0H <br /> Payment Summar <br /> Claim Na: 757 .y <br /> Claimant VAN DE pot EO <br /> NTMSES,INC. <br /> Request No: 23 Reviamer Nina Cjanl� <br /> Region: 5 Date: <br /> 5�_W_ <br /> PLEASZNOTE: AsstabadonihBpay ant <br /> 1,054-00 1,054.013 0-00 he o�10ra&XI 0j vw rqmucrrsLj!wygtem is no LGrxjarcosl cffe0m <br /> 11202 0=1;M CLj�j,,are beN reimhurwd WI <br /> and does notappear nGw93wY- pmmed Ware you <br /> raquasi as rf*M W MD ChEiRk-V-Ta I <br /> received U%9 last PGrYmeM summary- However,tutusrelatedrecei vMwAjLr0Irjc-a6un. ThsPaYmOnI <br /> COSM-y6ff inuLbe wbYWr5zd.f <br /> jW!Awq tyaju does not aWe9T 1`0 M <br /> summary futWerstatud <br /> signUicant conftajrtatim at INS site,it may ba oDnOdelW for I" <br /> risk donut. HaV9 YOU addressed ffla issue with your ragulatuTy <br /> 11472 MIMS7J079.38 <br /> 39 <br /> OAD <br /> 11633 01)!141013 20e25 20625 <br /> 5 11574 09{!!01162.535.G0 2.535. O.Do00 0.09 <br /> 6 <br /> 11665 '09fime 1,m2.30 <br /> T 11709 Ogr30106 2,535J00 2,5m 0 0.1111 <br /> 11747 10110!06 1,139-96 1,139 96 <br /> Ir I <br /> 151r S' P!, <br /> ILI <br /> zr <br /> FIdImbursomeM TMIM 6377,575-65 0.00 <br /> Current Fteimbuirsemw& 16,195.25 <br /> to Thq next'Sx—dshleev inifte <br /> 4,—Carry tho'�.;o arn <br /> eqLpostec� "ThW Party Oasts' <br /> FOOTNOTES <br /> ZqvZ <br /> Page of I <br /> gee,ion,2a121A)reqtflres ftee bids furmnY wtOrkaftar Dgemnlier-2nd,1991,or cosi eligibility mpy be counppomisad. <br />