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Dawn Marie Rabon, a child care provider, received a net payment of $84.96 from the C2AP - 632 child care program for services provided to Treyvion Berry from September 1-30, 2011. The gross payment was $414 but was reduced by a copayment of $329.04. This payment statement from October 17, 2011 shows the details of the transaction.

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388 views

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Dawn Marie Rabon, a child care provider, received a net payment of $84.96 from the C2AP - 632 child care program for services provided to Treyvion Berry from September 1-30, 2011. The gross payment was $414 but was reduced by a copayment of $329.04. This payment statement from October 17, 2011 shows the details of the transaction.

Uploaded by

branch_dawn
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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October 17, 2011

Child Care Provider Payment Statement


October 17, 2011 Page 1 of 1

Provider:

Rabon, Dawn Marie 27433 7th Street Highland, California 92346


Family Child Payment ID / Period
1301001 Berry Treyvion Berry 09/01/2011 to 09/30/2011

Vendor # GL Code

047046-01 7782
Pay Amount To*

Program

For

0632
C2AP - 632

Child Care

Gross Amount Less Copayment Net Payment Amount

$ 414.00 $-329.04 $ 84.96

Total:

$ 84.96

*Pay To: V = Vendor


P25

P = Parent
1111 Mill St Suite 100, San Bernardino, California 92408 (909) 890-0018 Fax: (909) 890-0032 Printed by KinderTrack

Printed by KinderConnect on: 10/31/2011 4:35 PM

October 17, 2011

Child Care Provider Payment Statement


October 17, 2011 Page 1 of 1

October 17, 2011 Family Fee Totals for all statements printed in this batch:
Program Subtotal

Grand Total All Statements Printed in this Batch:

$ 84.96

Family Fees

Total

0632
Total:

84.96 $84.96

0.00 $0.00

84.96 $84.96

*Pay To: V = Vendor


P25

P = Parent
1111 Mill St Suite 100, San Bernardino, California 92408 (909) 890-0018 Fax: (909) 890-0032 Printed by KinderTrack

Printed by KinderConnect on: 10/31/2011 4:35 PM

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