Case Number: 87C 00096
File Date: 05-29-1987
ST OF KS EX REL SRS
Address:
MANHATTAN, KS 66502
DOB:
Attorney:
MORFORD, THOMASA
Address:
(BC/BS CHECK)
ST MARYS KS 66536
DOB:
Attorney:
| Receipt Number | Receipt Date | Payor Name | Total Amount |
|---|---|---|---|
| 147 | 04/07/1992 | MORFORD/STATE TAX SET-OFF | 0.00 |
| 286 | 04/21/1992 | MORFORD,T/BLUE CROSS/BS | 0.00 |
| 615 | 05/18/1992 | MORFORD,THOMASA / BC/BS | 0.00 |
| 1077 | 06/29/1992 | MORFORD,BLUE CROSS BS | 10.00 |
| 1102 | 06/29/1992 | MORFORD,T/STATE SETOFF | 0.00 |
| 1452 | 07/28/1992 | MORFORD,T/FEDERAL SETOFF | 0.00 |
| 1646 | 08/10/1992 | MORFORD/BLCROSS/BLSHIELD | 10.00 |
| 1758 | 08/24/1992 | MORFORD/BLCROSS/BLSHIELD | 10.00 |
| 2101 | 09/21/1992 | MORFORD/BLCROSS/BLSHIELD | 10.00 |
| 2423 | 10/19/1992 | MORFORD/BL/CROSS & BL/SHL | 10.00 |
| 2574 | 11/30/1992 | MORFORD/BL CROSS/BL SHIEL | 10.00 |
| 2625 | 12/28/1992 | MORFORD/BL CROSS & BL SH | 10.00 |
| 2624 | 01/25/1993 | MORFORD/BL CR/BLUE SHIELD | 10.00 |
| 2652 | 02/22/1993 | MORFORD/BL CR/BLUE SHIELD | 10.00 |
| 2688 | 03/22/1993 | MORFORD/BLUE CROSS-BL SH | 10.00 |
| 3015 | 04/19/1993 | MORFORD/BL CROSS/BLSHIELD | 10.00 |
| 4158 | 07/16/1993 | MORFORD,T/FEDERAL SETOFF | 0.00 |
| Description | Transation Date | Amount Paid | Payor |
|---|---|---|---|
| C/S STATE (7-02-91) | 04/07/1992 | 69.00 | MORFORD/STATE TAX SET-OFF |
| C/S #379759 | 04/21/1992 | 10.00 | MORFORD,T/BLUE CROSS/BS |
| C/S #381424 | 05/18/1992 | 10.00 | MORFORD,THOMASA / BC/BS |
| C/S #383955 | 06/29/1992 | 10.00 | MORFORD,BLUE CROSS BS |
| C/S STATE (6-16-92) | 06/29/1992 | 86.00 | MORFORD,T/STATE SETOFF |
| CS FEDERAL (6-19-92) | 07/28/1992 | 344.00 | MORFORD,T/FEDERAL SETOFF |
| C/S #385677 | 08/10/1992 | 10.00 | MORFORD/BLCROSS/BLSHIELD |
| C/S #387330 | 08/24/1992 | 10.00 | MORFORD/BLCROSS/BLSHIELD |
| C/S #388742 | 09/21/1992 | 10.00 | MORFORD/BLCROSS/BLSHIELD |
| C/S #390608 | 10/19/1992 | 10.00 | MORFORD/BL/CROSS & BL/SHL |
| C/S #392909 | 11/30/1992 | 10.00 | MORFORD/BL CROSS/BL SHIEL |
| C/S #394839 | 12/28/1992 | 10.00 | MORFORD/BL CROSS & BL SH |
| C/S #396249 | 01/25/1993 | 10.00 | MORFORD/BL CR/BLUE SHIELD |
| C/S #397969 | 02/22/1993 | 10.00 | MORFORD/BL CR/BLUE SHIELD |
| C/S #399865 | 03/22/1993 | 10.00 | MORFORD/BLUE CROSS-BL SH |
| C/S #401515 | 04/19/1993 | 10.00 | MORFORD/BL CROSS/BLSHIELD |
| C/S FEDERAL(4-12-93) | 07/16/1993 | 690.32 | MORFORD,T/FEDERAL SETOFF |