Beruflich Dokumente
Kultur Dokumente
USCiS
P.0.Box 660045
Da as,1)(75266 0045
A Stnatu
or1 4 r RosuctOd Dellvery 19 deslred. Prlnt your nalne and addmss on he reverse
l
X
Q
D. b delhBy
lf YES,
A9ent
pom
"nt r spa
=
.
fitd
addlB
bolow:
No
I USC:S
IP,0.Box 660045
' Da as,TX
75266 0045
3 Sel o
Ty
cemed Mal
CERTIFlED MAIL
RoO d
!
Mall
Exp co
Mall
dB
2
PS
01670000268419483
Offisdc Rmm Redpl
!q
i .lqrod
l.rol
sl
(par6b6u
luau*ropu3)
dl 0 u LVn c :J: u 0
Pa" 3118 1
Juncrh,
tuEdo
EnglewcocL Calorada
1,11115tll :: F
14:!:;!:7:2i81:003,
14-555407637
465.00
1
PAY EXACTLV
ORDEn OF
PAY TO THE
DHS USCIS
PAMMENT FOR/ACCT #
len Mata Navarrete Ennio Diaz, AL b V'q[( P 5615 Richmond Avenue, Suite 250, Houston, Texas
7700 SSmAlt
:: 11 ttillS
NEl
NO CENT3
4=s5
407ae7
'r'i
Part 1. Notice of Appearance as Attorney or Accredited Representative A. This appearance is in regard to immigration matters before: 82 d 765 E CBP - List the specific matter in which USCIS Litt thc forrn numbcr(s):
ICE - List the specific matter in which appearance is entered:
appearance is entered:
as attorney
List Petitioner. Applicant. or Respondent. NOTE: Provide the mailing address of Petitioner. Appticant. or Respondent being represented, and not the address of the attomey or accredited representative. except rvhen filed under VAWA.
A Number or Receipt
Middlc Number, if any
! I I
Petitioner
NAVARRETE
KAREN
MATA
Applicant
Respondent
Apt No
City
Statc
Zip Codc
132 3
KNOLLCREST STREET
HOUSTON
TX
770 5
Pursuant to the Privacy Act of 1974 and DHS policy. I hereby consent to the disclosure to the named Attorney or Accredited Representative of any record pertaining to me that appears in any system of records of USCIS, USCBP, or USICE.
Date
2-28-2012
,pp s ,
`
tr
I am an attorney and
ofthe bar ofthe highest court(s) ofthe follorving State(s). possession(s). territory(ies),
TEXAS
Columbia:
I am not
B.
I or !
am subject to any order ofany court or administrative agency disbarring, suspending, enjoining,
tr
restraining, or otherwise restricting me in the practice oflaw (Ifyou are subject to any order(s), explain fully on reverse side). I am an accredited representative ofthe follouing qualified non-profit religious. charitable. social service. or similar organization established in the United States. so recognized by the Department of Justice. Board of Immigration Appeals pursuant to 8 CFR 1292.2. Provide name of organization and expiration date of accreditation:
C.
I am associated with
The attomey or accredited representative ofrecord previously filed Form G-28 in this case. and my appearance as an attomey or accredited representative is at his or her request (lfyou check this item, also complete item A or B above in Parl 2, whichever is appropriate).
Part
3.
I have read and understand the regulations and conditions contained in 8 CFR 103.2 and 292 governing appearances and representation beforetheDepartmentofHomelandSecurity. IdeclareunderpenaltyofperjuryunderthelawsoftheUnitedStatesthattheinformationl
have on this form is true and correct. Attomcy Bar Numbcr(s).if any
Namc of Attomcy or Accrcditcd Rcprcscntativc
ENN O D AZ
24028299
Datc
12-28 2012
te Address
ion of Accredited Representative (Street Number and Street Name. Suite No.. City. State. Zip Code) 4ail Addrcss,if any
INF00HOUSTON DA.COM
Form G-28(Rcv 04/22/09)N
765,Application For
Action Block
Fee Stamp
A#
lApplication
until
(Datc)
(Dratc)
Hsh Fdd
Failed to cstablish cconomic ncccssi aS rCquircd in 8 CFR 274a 12(c)(14).(18)and 8 CFR 214 2(o
I am applying for:
/2
`
: !_ (Middle)
S 0 9 Datc(s) Dal
7_ `
KAREN
ONES
MATA
Results (Granted or Denied - aftach all documentation)
(Apt. Number)
2 8 g " us
13 Place of Last Entry intO thc U S
tmm/d "
(State/counw)
(ZIP COdC)
HOUSTON
4 Countty of Citizcnship/Nationality
TX
77015
MCALLEN TEXAS
14. Manner of Last Entry'(Visitor. Student. etc.)
MEXICO
5 Placc of Birth(ToWn Or ci ) (State/Province)
EWI
(COunty)
15 Current lmmigration Status(ViSIOr,Studcnt,ctc)
SAN
AVIER
TLALNEPANTLA
yyy)
MEXICO
7. Gender
MEXICO
OUT OE STATUS
16. Go to Part 2 of the lnstructions. Eligibilit_r Categories. [n the space below, place the letter and number ofthe categor),.vou selected from the instructions
(For cxalnple,(a)(8),(c)(17)( i),CtC)
Eligibili
09/21/1988
I va. lE re.ul"
E
oirlo,..o
)
E wiao*.0
) (14
)(
9. Social Security Number (include all numbers 1ou have ever used) (ifanr
(if
any )
17. If you entered the Eligibility Category. (c)(3XC), in item 16 above, list your degree, your employer's name as listed in E-Verfu, and your employer's EVeriff Compan-v Identification Number or a valid E-Verifz Client Company Identification Number in the space below.
Darr""'_
11. Have you ever before applied for employment authorization from USCIS?
Employer's Name as listed in E-Veriff: Employer's E-VeriS Company Identification Number or Client Company Identiflcation Number
a
complete
below)
No
valid E-Verifu
Certification
Your Certification: I certifi, under penalty of perjury under the laws of the United
States of America, that the foregoing is true and correct. Furthermore, I authorize the release of any information that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. I have read the Instructions in Part 2 and have identified the appropriate eligibiliry category in
Block 16.
Tclcphonc Numbcr
/
Address
(832)889-8313
12/28/2012
Date
I declare that this document was prepared by me at the I have any know which information of request of the applicant and is based on all
Print Name
Ennio
Houston
TX77o57
12/28/2012
Datc
Forlll I
USCIS 765WS
l4), Deferred Action, or (c)(33), Consideration of Deferred Action worksheet this to establish your economic need for employment pursuant to complete for Childhood Arrivals, eligibility categories, documentation, though it will be accepted and reviewed if you choose to suppofting is not necessary to submit 8 CFR $ 274a.12(e).lt lf you
are applying for employment authorization under the (c)(
submit it.
NAVARRETE KAREN
1.b.
(First Name)
1.c.
3.
5000
0
4.
I WOULD LIKE TO BE
EDUCATION
Page
I of
USCIS
Form I 821D
OMB No 1615 O124
Expircs 02/28/2013
For
L________
ID:
Requestor interviewed on
Receipt
Action Block
USCIS
Use
Case
Only
Retumed:
/ /
Received: / Scnl: / /
Remarks
Resubmitted: /
>
:W
24028299
Remov al Pro
ce
din g s I nfo
rmation
3.a.
lves
XNo
a
Full Name
1.a.
If you answered "Yes" to the above question, you must check box below indicating your current status or outcome of your removal proceedings.
Family Name
NAVARRETE
KAREN
3.b.
Type ofproceedings:
1.b.
Given Name
lFtrs
a.
fl U. I
Currently in Proceedings
edministrarively Closed
! !
1.c.
Middle Name
MATA
3.c.
Mailing Address
2.a.In Care ofNarne
2.b.
3213
KNOLLCREST STREET
2.c.
ept. !
Ste.
tr
Flr.
tr
770 5
2.d.
City or Town
HOUSTON
2i. Zipcode
Fol
ll I
821D 08/15/12
Page
I of6
Sr s, , ,
EWI
4.
5.
!ves XNo
List your I-94 number /
>
17.
(l
any)
Date of
Binh
(mm/dd/yyy)
09/2
988
7.
"
8 a
Education Informotion
18.
8.bo Country ofBirth
Mex co
19.
9.
Current Education Status 1e.g., In School, General Educational Development, High School Graduate)
Of Citizenshi
20.
Date of Last Attendance, Graduation, Receipt of General Educational Development Certificate, and/or Completion
l.
Marital Status
Certificate
Widowed
fum/dd/y119
0/03/2007
I Manied !
[] single !
Divorced
Part7., Additional
!Yes
XNo
ONES
(First Name)
KAREN
as
13.
/ > 03/06/ 995 , >
14.
` `
orm l 821D
08/15/12
Page 2
of6
Address 2
l.a. l.b.
4.a.
4b
ftves Euo
I have been continuously residing in the United States
since at least June 15.2007.
To:
/0 /20 0
.3 KNOLLCREST STttET
Ives
ENo
4.c. ept.
4.d.
ste.
tr
4
Flr.
tr
770 5
NOTE: If you answer "No" to Item Numbers l.a. or 1.b., use Part 7., Additional Information, to include a full
explanation.
City or Town
HOUSTON
4Q ttc
Address 3
ZpCde
List your current address and, to the best ofyour knowledge, the addresses where you resided since your initial entry into the United States. If you require additional space, use Part7.,
5.a.
5.b.
From:)
/02/2003
322
To:
) 03/15/2005
Additional Information.
Present Address
KNOLLCREST STREET
5.c.
2.a.
2.b.
Apt. E
Ste.
HOUSTttN
ZpC e 770 5
From:) 10/30/20 2
Street Number and Name
32 3
To:
Pres ent
5.d.
City or Town
KNOLLCREST STREET
tte
2.c
ept.
I
lTx
Ste.
L
HOUSTON
I
List all your absences from the United States since June 15,2007. If you require additional space, use Part 7., Additional
2.d.
City or Town
State
2.e.
Address I
dal)>
",
3.a.
3.b
6.c.
To:
0/30/2012
7.a. Departure Date 2 ` /
3.c.
Rpt.
ffi
Ste.
tr
Flr.
tr
25 2
rF7 /d
3.d.
City or Town
HOUSTON
ZpC C 770 5
7.c.
tte
FoHn l 821D
08/!5/12
Irage 3 of 6
l.a. [] l.b. I
I can read and understand English, and have read and understand each and every question and instruction on this form. as well as my answer to each question.
Each and every question and instruction on this form, as well as my answer to each question, has been read to me by the person named below
1.
Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor in the United States? Do not include minor trafic violalions thot only resulted in a fine, unless it was olcohol- or drug-related.
f, Yes INo
If you answered "Yes" you must also include copies of all arrest records, charging documents, dispositions
(outcomes), sentencing records, etc.
in a language in which I am fluent. I understand each and every question and instruction on this form, as well as my answer to each question.
Req
States?
lVes
XNo
United States of America, that the foregoing is true and correct. Copies of documents submittcd are exact photocopies of unaltered original documents, and I understand that I may be required to submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from my records that USCIS needs to reach a determination on deferred
action.
Have you ever engaged in or do you continue to engage in or plan to engage in terrorist activities? yes No
2.a.
4.
Are you now or have you ever been a member ofa gang?
2.b.
3.
12/23/20 2
f Yes X tlo
Have you ever engaged in, ordered, incited, assisted or otherwise participated in any of the following:
me hme Numttr( )
-8313
5.a.
! Yes XNo
5.b. Killing
any person?
flYes
NOTE: Deferred action is unlikely to be considered for anyone who fails to completely fill out this form or to submit required documents listed in the instructions. Deferred action does not confer lawful status upon an individual. Furthermore, a decision on deferred action is wholly within the discretion of DHS.
No
5.c.
5.d.
[Yes
XNo
Any kind of sexual contact or relations with any person who was being forced or threatened? 3 y., X No
For USCIS
Use Only
Form I 821D08/15/12
Page 4
of 6
Part 5. Signature of Person Preparing This Request, If Other Than the Requestor
NOTE: If you are an attomey or representative. you must submit
Notice of Entry of Appearance as Attomey or Accredited Representative, along with this request.
a completed Form G-28,
Preparer's D eclaration
aul hor
To be compleled b1, all preparers, including attorneys and iz e d r epr es ent at iy es.
behest. that
I declare that I prepared this Form I-82 I D at the requestor's it is based on all the information of which I have
1.
Attomey or Representative: In the event of a Request for Evidence (RFE), may USCIS contact you by e-mail?
[Yes
Preparer's Full Name
ENo
of Preparer
7.b.
(lasl
trr,
2/28/20 2
s Family Name
2.b.
3.
I certifu that I am fluent in English and the language above. I further certify that I have read each and every question and instruction on this form, as well as the answer to each question, to this requestor in the above-mentioned language, and that the requestor has informed me that he or she has understood each and every instruction and question of the form, as well as the
answer to each question.
4.a.
Street Number
andName
4.b. Apt.
Ste.
FI
2.a.
Signature of Interpreter
250
2.bo Date of Signature"
4.c.
4
Ciry or Town
HOUSTON
)>
4a ZpCde
77057
0 ria
3.a.
)[ 7051
3.b.
Inte
INFOCHOUSTON DA.COM
FoHn I 821D
08/15/12
Page 5
of6
3.a.
3.b.
DELrNeuENcy,
TE WAS ARRESTED ON
N
MARCH 3 2004
HARRIS COUNTY
TEXAS
GRAMS AND CHARGED WITH A CLASS A MISDEMttANOR. THE 313TH DISTRICT COURT OF HARRIS COUNTY ENTERED KAREN WITH A SENTENCE OF
2.c.
1.b
Givcn Namc
UDGMENT
ON
rF7
1.c.
YEAR PROBATION
05/24/2005.
CRIMINAL RECORD.
2.d. 02/0 /200
TO
0
/02/2003
4.c. Item Number
HOUSTON TX 770 5
02/0
/2001 TX 77013
4.d.
HOUSTON 54
08/02/ 996
2
0
TO
01/05/2000
08/02/ 996
/02/ 996
/02/ 996
FoHll I
821D 08/15/12
Page 6
of 6
Chris Daniel
HARRIS COUNTY DISTRICT CLERK
P.0.BOX 4651
HOUSTON,TEXAS 77210-4651
rr
`
6rR
`
/ S c
DATE: 8/30/2012
NAME:NAVA
TE
MATA,KAREN
DATE OF BIRTH:9/21/1988
erc found on thc d scarch vas conductcd fl onl 1976 to thc prescnt and no crilllinal charges vas conductcd using the individualis nalnc,date ofbirth, above individual. This crilllinal rccord scarch and/or Social Security nunlbcr.Records pertaining to fedcral entities,other Counties', Justices ofthc Pcacc lunicipalitics'Class C lllisdclllca110r wiH NOT bc displayed. or othcr
This ccrtiflcatc is issucd only as to a search conductcd for rccords on flle with thc District Clerk of Harris
COun ,TCXas.
This record search does not include nalllcs ofdcfcndants,indictcd directly by the grandjury,unless the dcfcndant is in custody or ulldcr bond,pursuantto Vcrnonis Texas Ann.C.C.P.Article 20.22.
a
Chris Daniel lf
District Clcrk HaFriS COunty,Texas
(713)755
73() )
THI STATE OF TEXAS VS
ORDER JUDGE :alld SHPULAl TO THE EVIDENCE:orNOI.O CON INDE ER OFJURY TRIAL BttORE C01JRIttr 200403213J ttll qucnc
FI
ROFrml
IN TllB 3i3 rH
Fp
OF HARtt COUNTY,TEXAS
Date ofJI m t 525/2004 Dllte oFDispttdo 5 D/2004 ProbatioD Btti :5252
P ba on Endlllg:52 005
.MAY 2 5 2m4
-l
AnyoL r
rany.
11ons ted
On 3 312004
'E
Z MISJ Or Fclon 3N
mtt lMu Fd
Mi C
!
l Rl yl
! " wC"l
Amrntative Findi
LBst FsnTont
ed OrMPL rv l Li tt Dttposiro NIcc sS ry i child foulu nottO LvtS engard ln Delinqwnt Cttr uctorto be a Cbnd h nL
need f
itt r sI
lll E :ibi
B in
Val.h
cOtm mher rlndsthtthe H3rrtS County Jwenl Probaton Deparment Weapon-lrnlattd descrlbe pe ofttapo
andplncem
E DL adly
!
lle Onels OF Cotltt nded Declared lb H All P o Rulcs kmaln ln EfFt ct L PrOb t10111 "Vio13tcd
v"
"
M tttFttmm
Custouy
Cwmdy c,PO
paid th" h:blS C00nty Distnct Ch PO.B 4651,IIou : Tx 77210 4651 cOur cOsts ttnds shal depodtt mto the Harls County Cencral F
`o bc
bt
Supevi tt
ltobe F
9 3hal!bc Suri30ry F
:IIanls C unty
InabI"tO tt the PayHads Coullty Ceneral hnd P3re WAIV ) Dtt "jted "rvisoty FI pcwO 5)5hl bC 3pOnSiblc ror 1l p y The fonO ng
:
Collllnun
ySu
Number or Lo
"and tcrlns:
Attom"F 3
c
P03
61.Houston I 7 10 4651
d o H COunty
Cencral F
Attorney es P yoe:
shJl be
`N"
2 32 JJ
P ge I of
-1
'
JUDGUMENr 2m213J p
oRDER
y cque
m10,H"slon, lH5Cm8ns R
77002.
of
" to be paid . thlnltlal parm duc by Tbc tolowing person(s t shall br' resprmsiblu for full payracnt:
to bc paid
of
of
to be pad
wrh thiperntduC
br,
by
po ncm
Rcstitution Payee 3:
for tlc
of
. thi inlpaFalduC by Thc toltowful P(T!olr1s) shsll bc rcspomiblc for full paymenc
tobe"ld
to Rcstihrtion PaYee 4:
chnd support
Child'S\pporr rics sboll tr Child Suppon Plycc: Tk following pusouls) sball bc uponsiblc for fullpityocm:
T!.xos ?8!65-9791'
No Drivrr Liccns'c Rrstsictions (i) thc Tcxas Farily codr:' Tlr rcgpondcnt's tbuntprinr ir affxcd lo $i! ordcr. in conPli lce nith sclrlion 54'O+ of tlrrtof) (Thumbprir is attachedand mr& a pan of this order
Rctffctlou:
ll
thG
fouoning progrrd!
pccr
Worfsho
I fircrcttcrs ii
Prcsrm
[-i
family
Counsrling
r'
Dru8
FNYouth
l.]TDcounEidlIlGangrvort*noPElrditidullcou[itlinfl.rnSsr}rrngSpflrntq)u$dinUugrtn,r
Il
GtD
Prognor
sa oltcndrr
Spcclal
lortruaionr: DAET E c, arg - s' conaat I t Dcfcfrcrt sx olfenlq Lcsirtstion fl No Colt0ct - Co{tplahant !-f Gaag cssclo"d - |No Cotrrrct - CoAclors M Lcter Of Apology M f."oao], pn g so"oo ll Regir6r As Sr'x ofic1d3r E No Conuct - Gary Mcrnbers L: Educationol sFcialbt !l Menror
Rulcr of Prcbrtlon3
cny ch.mgc of arl&es, sctrool or employrrcnt Rl . I wi[ Iport to ory Jwcdle Plobotion ollicer, as rcqucsted, ald will n'port within ibrcc ilays. hl$e an-ercuscd abscmc' oR' if [u, t wiu sttcod my homc rchoot or a.md|!r accredittd scbool (all clas6cs) c\tcry &y. unlsss I from ichool to mv Juveailc cverv sb6"nN :* tpurs w,thin ,*port r ;gJly;li[;-6ofo ;uot, wirt
Probation Ofliccr. sill leaye thc couoty only with my Juvmilc Probation ofiiccr's &3. I will rsEain wiltdn the limis of Hrrris c{lnty ald pemrissioa or whm iu fic corpeny ofmy psrcqs) or Susdirn: 'f+. f *iiirot riof"t arry ta* oirfi Sturc oi thcc ofany placc I nroy bc located' tbc rulcs of nry placcmcct' ii. i *iii *, r".* ry tlourt Placemcnt without lawtul Pemissiorr md I wilt obcy all fmm Surulay t roryh Tbrday aad by 7:00.PM r'rn Fri&y;rnd R6, I will be iu my Court placs6nt cach cvcning by 7:00 PM permission liom my Juvenilc hobatioo Offic{ or OOO a-Na. ;cit i"i[ilV,qgl, uot *. I havc spiific Ssu,,day
(b ,"n,in ,utif
l xatron and tinrc spccifie".t by p(rsolncl of-llanis couniy Juveuile J#- fiiioanalysis Rg. I will submit nry.iclf ,o prior to sulxnitting spccitrn' A pmbEtion, rcvc.l i,o laid oudroriz,rt;;r;Jpt-ioii"y rrtOLnrioa lr:gntry prcscnlcd for o16 for nr nray Ksult in adjudication pruscribcd lCg ly nor nranluana. rubc oositivc for iny cofiollcd subslancc, dalgcmus drugF. or of dclinqucnt conduct or rtvocarion of prohation' Peacc or horss' aay cianions rcccivcd to apPcar bt'fore a Justicc ofthe R9. I will rc?ofi to my lu"cnifc noUatitn bf6ccr within 2{
iry
progrsE rcquirud by my
at
luvqilc
PDbadon Officcr'
-ur-
a_
C ll
JJHbar
'00`03 JJ
P 2
of3
srrPULArIoN ro
rfiD#ffil"lHH
**'*DERET
aud
Municipul C,ourt
record. unless You arc rcquired to suhnit 0 blood saEple or oher spccirra for thc prrpoac of crc8titr8 s DNA subnrittt{ tho rtquircd specicn rsder oftcr Sbtc L:w'
pu
hare already
wilh tbc abovc nllnrbr-red BE IT REMEMBERED 6al hi5 c8us being crllt'd for trial, cume otr to bc he&d beforc thc sbott co,urt widr his/h* Rcspondcnt hc ia caEL' ald Attomcy District Pcrson url cntitlcd cause ad carnc fte Sotc of TcJ" by h.t At.iran partic5 rvaivc{ a jury'and rrmuurcd ready lbr sll snd or cuslodiln(s) guldia(O, porel(t), orU rh Rcspondcntb a.e"". "tt"*y. opon rtre'courr. Jtii rrcarini-rt pr"adirig ot'"ll thr ponk]s atrd hr]dng the cYidem. rnd-argurrnt of couuel" froirgl " "nd ,o*uablc doubl thrt iaid cmd;or6;tied " thc otfensrls) all.gcd in th! pctition iDauor cstablishcd by thc cvidcnce i,r* U"ioA
[i*
"
erurSsd in dcli&Iucnt cotduct or IT IS ]TIER EFORE ORDERED, ADJUDGED AND DECREED by lhc cour thst 6c resPondcd
or custodias(s), IT IS FtjRTltER oRDERED, thrr Baid child ir hcrcby placod in tbr custody ot'said parcr(s)' Susrdian(s). 's for thc (if prcbation indicatql abovc) of t* ,uhs *U * rcspomilfc fu thc ctritdt carc lna phc!{nrDi uoitcr iUi"oled .Uor., ! which is EEd! sld hrrlro pogc "Ao atachcd the as lirtr'd on ond ;; *;;d 36,)"", U, *t o or t"zo"a t. on Cr tErh birrhrlay.
prd of this fidcr hc(eof' subidt !o furltol o[doB of thc Court' of the commnity fortlx! chjld Ej Thc coun find, tlat it is in thc bcst intlrtst of 0rc child ard
rhc rcason6 stcrcd iD uuuit e iacorponrcai.r"io. ard thB O)urt oPprovcs rorPral.
fU
to bir plac!'d oubide his/hT home for has becn ttrooltd ftom bir/hcr hornc thc chitd ihrr fisds furO,:r corrt
the need for thc cbild to bc rcnnrtd from TIlc ctun flro& that reasosable ellprts neru rm& to prcvcnt or elimiute as re&rcrlccd in Exhibit B incorporated bn:in'
hi{[cr
hon:e
IT
JS
[I
placemrat cart' ris County Juvcaib ltobatioa Deparmru bc n:rponsiblc iior child's
ppeal L accOrds tr 54.04thJti and as bysmOn56.01 E CHILD WASN Tl n .ftt ightt httner 3hito 6 l hin cOdBin accorance dl ch ptc Chnd Fatt Ctt F 0f " COde lillg rt c h Section 58 003 ofm Tex"
54.04 hl12).underitt procedlm for Se
ald cofful.
MAY 2 5
and
Sigrd
on this tbc
--20.-
Ju rs
RIGHT thunlb"nt
Gr r
WII"
03r3J
Poge 3
of3
1:)
to"r*ru,r,
.,
PCS--&M-.
FEr,oNy ADuoNrsHMENr
15 .
EfEE-EEE8EE iluveal'le RespoDderit ln the above srtitled and nuEbred cauEe, ln writlllg and In opn court, and congents to tlre stlgrlallon Of the gvidence ln thie case and in go doing expressly walveg Ehe appearance,
COUBS NOTI
confrontatlon and croaa-erGlrination of witBesses, (the right to a trial, alrd Ehe rlgh! to a tfial by jurv. ) x further consetrE Eo the introduction of tseBtlDoEy Ef affidavitE. written statements of witaesEes and otbsr doeuDentary gridence. Accordlngly. havlng waived qf Fe'leral ard Statse congtiEutional right against 81f -incrLmiaation and aftser havJ.ng been auorD, upon oaEh, I
judlcial'lyconfesetothEfollrylrerfactsand'agreeandgtlpulattshatstsh faclsaretrueandcorrectandcongtitutsetheevidencelnthiscage: r wag born on the.gC-ElI-gfSElEB, 191S. 7l CorEty lEd gtrt' ol !rcr'r' r i!Ll G tb. 31m Df,Y ot nnci- 2OOa, tB ElErl.ed tDolrflgl1, Do.r.tt 11 c@tto1l'd *or .aaffit@r1y tDla 28 grele !!, amEogrrto l.tt ratgtl!0f rrrbtt !c., lrsly, IIdEEIIOM, allutlltr rDd ttigbt, fEcludfDg 84r rArlt'rtrt3 ' cotttal t!. .tc...r.d al'l.g,.d It l! firtt,b.! trotctrd t[rt tt n iD@d8t gt r<ihool r DDU|, )8rlE8UAl EIf a l. rc oitmr. of rrll. PRODBET thrt
gcmo!.
and
I agree to Ehat
reconutendaEion '
-7
R28P
I conaent to
e\ridence
.
aDd approve
HARRISycOUNTY T E X A S
`.
:P
or
! 200r
strict
CourE
Alxrroved:
lutttAcAis,I)
AY 2 5 2004
riml
Court
dN
TIIE STA OF TEXAS
VS.
JLIDGEMENT ORDER STIPUTATION To THE BVIDENCE: or NoI.o CINTENDERE; COURT WAIVER OFJURY TRIAL B
2004 03213J RoOponed
end
IN
NAV
AKA:
,1
rl
l... Attomey br :ESSFCA CAIRD LLO Attomy for Rc spondcnt ttRK A.CA
hereby mm 0
30
:
: 1
. Rc8POndOr8
1 :
OF COllRT ORDBRED
Alt
B
y. Lb l. Jlar Cal.ls,r
Mirdcrn
5 0
L__ _ __
fE
Mb'r.'nrrxlt A
'I
El
}tid.rtlrrio(
Frlo
y 2nd
.Dc
r.chr
lit
-;
hcrny
ls
yW caphJ T relun
M C.hild fourd to h.ve cngpgcd in Deliaquqlt Conduct Attrm ave nndings Vl Ctitd inNccd of Rch.sbilft ion 10n cttd fbund tO b in"ed oF SIDc ,1 Is CuncntlY Eruoltcd Glld L ol Dttct Sidenttn Sch
E ctitdk Probatior is R
okrd
*
No Disposition Ncccsery
ill
gi
Child
ttr of the Tcfias Family Code' Disposition slould be madc for thc child's -iitpo.ial* Rrspoudcnt is I child rndcr tlr nraoing oiTitle l. in ,r, ucst iaten'st or iaid child's hcalth' safety' rnrals and pmrcction and for th. p.orcction Jr-til iriiuc.
c&rc{tion.
ford
rcd
of
Srycn'isi@ E
ft
will bc scrvcd by r.rDving hc child Aom hiyhsr hoote Corrt fio.f, d"t thr b(.e i,tcrcst of thc clild ed of th comufiity ttrir rcascnablc cfloT e uere mad' D PrcYcnt or climilsl'c th o" rEfrrcaced i, Erbibit A i!cqeo;; ;.it , ua tU Corut frUs possiblc to Etum bon: as nftrcoced in Exhibit B iscorporatrd mrkc it nccd for ltc chitd'r nrmvEl ft"--tl*;;;;; 'lhc bi.Vhcr homt and ttc C'o:rt eppmvcs thc rcrmval' harcin. IT IS FURTHER ORDERI{ th.t 6; chilrt bc rcnrovcd tiom ploccnlrot'
Court fiuther linds thot fUc
Il
Dea<tty Wcapon -
to cDqdirrcu$odim *Eirt l] cu.bdy to Rcttivc E c$tody to MHlttlA f- | cudody IsP lf crsodv t'r o*ct ; I ormai o r*ortc, lf Joittt curodv pnt A cu*odv !o cJPo mr'ps D c,soty I ctorroy. o
tr'oi*ry
to
rn
Prrc
(t),
Gurrdh{rL or Curtodiru(3)
herc:
Houstoo Tr 772104551' b P.irt tbrotgh: Uarris Coumy DisEict Clcrtq P'O' Box '1651' Conrt ---' Cortr --- to FurJ Gcoeral c'urnty tbc Harri! i o Coutt'Coug fuu& shrll be dcPGitcd Court Co6E
Psyre: wAlvED
bG
supcrvisoryfec'tobcpaidthruugh:H{riscoutyDistrictclclk.P.o.Box465l.HorrstonTx712l0-4r65l. Gencal Fud Supervisory fces ctdl bc dt?ositcd ido tlE Harris County Pay to Supcrvismy Fca Paycc: WAIVED - Duc to llBbility
Itrc following
24 HRS
brB:
dcpositcd into thc llarris C'oumy Geocral
Atlowv
Atbmy
C
trcaa
P'O' Box 4651' Houstm T!( 7721G465 l ' Arr.aacd ro be paid through Hanis Coudy Disttict Clerk.
enori.y
Fcs PsYtc:
f.."
ti"U
Ue
l\nd
WAIVED
P 8e
"
2 JJ2rJJ
l of3
JUDGEMENT ORDER SIPULATION TO THFIEVDENCE:orNOLO CONrENDERE; nd BEFORE COllRT WAIVER OFJURY TRIAL
Opened 2-13213J R
Rttltutlon to be paid
in the anruot
"usb:II"r
Child Support D
of
of
to be pEid ,wllllnltt p due by Thc following pcrsor{s} 8b!ll be rssponsiblc for full payrcm to be ttd
l e fo owm8
of
of
. inltt
s,3ba
b
ral
g..lr[
of
Pa by p 9 fortt pm
lby
to RcEtiotim Pa),!c 2: h thc urunt for tE loEl srE of to Re6dnnior Paln:c 3: in 6c r,tDunt
tO be pald
w lpernt
of
for
tb otrl
srm
of
o bc poll
follo
to R.cstitldo! PayEc 4:
b CSponslble for mo Sh
]p3-t:
n Anmtl
Chlld SuppoH
' 7 1
s7 "
with B] Thc respondeot's rhmbprint io affxcd to this order, in conplisltc. tbrcoD this o(&r (Thurltpdnt is ach.d rnd madl ! Port of Rcrpodcnt lr ordcrcd to prrd@E ln thc foflorlug progreur:
i-
wcaponr
wortsho [J
|-]
rircxncn
Grng
[-l
pc",
prcrerr"
lI
rmity
curnctlng
U mC
Ortcrtr
i-
cED
r,ogrsnr
Wo*shop
fl
lndividsEl
UUUne
Spetrl Inttructlonr: FOLLOW ALL RI II,ES JPO E p, Avg - ,S, Codwr -J Dcfcrrtd Scx Oftndcr Rcgistrition fl No Contact - Complabam El oan8 casslosd E l.*o Contrct - CoActors C l*trr Of epology n n rAot pr,rg S"r.ens E Rcgism 43 Scx Ofredet
mffmfl*"' Dircctor
Mcntor
fl
Edrrational
Specialist
Ruler of
wil Ilpori
0try
R2. I will attad rry boDr s!.bnol or lnothcr accrcditd school (all clrssr"ra) cvery Echool, !'l l s,o* full tirt each day. I wilt n?ort withi! 24 tegauy exqscd
to;
&y, rmlcsc I hove an-cxclEed ab6oncc' OR' if hflrs evcry obsoncc ftom chool to rry Juvcqilc
Prcbrtior Offfir. n:. i witt rcrrain wi&in t}r liEits of thrris couty ard will krvc rhc Cor.oty ody with tny JuYenile Probation OIEcer's permisiou or whcn in thc colryany of oly paEn(s) or 8ur-diarj it4. I wil Doi viohtc any trw of thc stotc or tho* of rny placc I nray be locrted' eourt PlaccDrnt wifhout lawful Frmirsnm, !n{i I will obsy nll the rulrs of my placcrrrru' tea"* nS . f *ili
R6. I
am
will
Sru&y
evming by ?:00 PM ftom sunday fluough 't'hursdry and by 7flO-PM on Friday and (to rcrnoia uotil 6:00 A.Irt cach d&y folLwing). Eless I hrvc sptlciEc putnission Aonr ary Jurrcoilc Probstion Ofiiccr or
be in my c,oun
-t
-y
Placannt
r.ach
Offic4r' R7. I will altcnd 8nd PstticiPsE in any prDsran rcquircd by my Juvcnilc Probation oi ic si":icn-lsrlysis at a location and tir:r sprriticd by persomel of Horris County Juvcnilc t"loff o nf . i ",iff rcveal to oitt rutorbc{ pcrsolacl proof of aoy nrdicaEor legally prcsctibed for rE Prior to submittin8 ry};imtn' A probrtion rnuijuonr, not lclally pnttribcd for ,IE may rcsult in rdjudication coatrollod substanccs, O"ogc-rr d"rg.., f* *i"" "rry " probation. of delinqucot cooduct or revu:ation of
*t.i
i"rc-
p;'t
`M " 2
%J32 JJ
Page 2 o
JTJIIGEIIIENT / OBI'ER
STIPUIi'nON TO TIIE EVIDEI|CIII oTNOIO @NTENDEREI and BEFORE COURT.WATVER OF JURY TRIAL 2&H{Xnl3J R&OPGucd probotion OIIicct within 2.1 bourq sny citatioDs rrccived to an[,car bcfo.tt Iuwnilc
o .fusticc
of
tb
Pcace or
you rrc reqpirud to subril I blood samplc or ottct tpccitrro br thc lf,trposc of ct.cding I DNA recond' uolcss you bovc slEady submittd fu rcquirEd spccinrca urdrr otrcr Strtc L.w
tsE
and
rr
c*irlcd
iu"tui"nttl. --"r"odiq(s) t6-"-i11g["y, .rra pr"li,iig orrl *o parties ooA dtring lttc c'lridcocc ald argurEnt of counscl' a hc[ing: rnd drrt rpo" s" C",lttr ;;i;id'u. o-u1 t t-*J"r,1a iorlIrirca oi om*c{si athga in ffre pstiiion ardor cat8blishcd by thc cvidncc ira" di"a
slsle oI to b h3ad bcforc tlp rbovc court witb tle sbovc numbcrtd itr Pcmol tF Rcary&m with his/lE'r ond c.ro tlo s"u of ic;s Uy i cr aoi.uor Oi*ia Atbroey aad cerc gu P6rrica waiyed r jury ud oruro'<ed reodv for 8!d tc Reryold.ldpo;;iti.
tir!
court 6at thc espondeat engaged h dclinqu.nt coEduct or IT Is TI{mEFoRB oRDERp, ADJUDGED AND DBCREED by tlu above)' is a child in mcd of ry.rvision (corlsisEnt wih thc affirmtivc findings
"-.*.iur.
ih DG,*)d irdilrred obovr. uur not to or'#i.-J of udus futtler to subjegt prrt of rut onact Ur*f,
gl
Tha court
aDd rha
tc rcspon*rtlc
gu0r. di!D(s)., or fl$odi0ds), us is horeby ptaced in tlrc cultody of soid parerq+ (if ildicstcd cbow) fio( thr prcbatior aud PlacetE+- u4er lho ru- lca of for tb child.l h,oto and which is rudc a pagc att.chd thc d"5 aud as lietcd m cr rge irr"
;re
th
tit
Cotut'
plas:d flds &st it i5 in th. bcst iltclEst oI thc child and of tlt comnunity for thc child lo bc rcmoved fi,mr his/her hont bccn hls cbild tbe ihrt a,cr fiDdE gtuuit n e ir"6ontea-rscii. fnc coutt dr. EErotrs statd itr
Court approwc rcnrova.l,
Thc court
!t
hiJhcr homc nfiG D|ad. b rcve[t or climim$ thc occd for thc child to br' rcmorcd from tcfutlcGd in Exhibit B ilcorpssted hcrrin'
fi!&
tlEl rtrloEabtc
GffDns
tT Is
tb
Deprrbr
rnd contlol
5'l'04(h1l ) ard as rcquird by scction TIIE CIITLD WAS NOTIFIED. of hi/hcr riglr to apped i! accordslcc- with cbPEI in accordancc wilh cheptcr hisflrct seal tightto ofth Tcx6! Family coao. r-mt, ilc-ii1a-*al ooli6"d oruvh"t ^*cords
;;.ildft]: *dt;G
tis
ths
AUO
3 I m(tf
A 8i
",313 th DIs
Ict COm
COutt Tem3
" "=
::
L_ _ ___
Juven RIGHr thunlb prlnt
"
321JJ
Prgc 3
of3
'
0.2004-032 3
OF SE(S)3
ELGT
HARRIS COUNTY
T E X A S
couEs Notd ElgscrsEEE .fuvenlle RespondenE ln Ehe above entit,led and numbred cause, in wrlting and in open Court, and consenEB to the stlpulation of Ebe evldence in lhis case and in Bo doing exDressly rraiveB the apgeara:rce, confronEaElon and cross-s)ninaEion of wiEnessea, (Ehe righE Eo a trial, and the right Eo a Er1al bV jury.) I further consenE to ttle introducLlon of tsEi[pn], hf affidavits, !,.ritten Etate.nents of wiEnesses, and olher documenEary evidence. Accolding1y. ltaving rraived rD. Fcderat and State coEsEitutlonal, righe againat, se1fincrimlDation and afier havlng beea sworn, upon oaEh, I Judicially confess Eo th folloYrlng factss and agrree and stipulate thaE the facEa are Erue and correcE and constituEe Ehe evidence in Ehia caac: r Yat 988. 0 t!. al- p ?_g@sgl, wag bo `` on the 2 3T ttY Or Sp_R c6ta{!d ttr lt 1tugu.at Glhrst lor tL prLuqr oltGaa of DOggEgAIN Ot I d.clr!.d to hrvc R ORT Z undor . d in th u t f r m m8 P msTA c m uDd.r a.u1.3 alrDervki,oll of ti. ErraLt CoqrEy iruvt dil'. Eobrtia tl.Dclrtttat Eattl lEE!-2lr-l!!g, o! trrobstt6 at ..E CoatL b!, tba cort, furt'brr adilltl6.6 Eql otbE rr'l Itl tbat I: Y REPOW TO S OL OREPLOm Y C LL
EIL LE 0. - 0
D=v mll moRDAT AND EACE EVH- 3Y 7300 2r g 38 =L mVE L 6300 AM FOLLmm) DAT (TO ttm -388 BY 7800 PH ` ttnaV tt sA 8W T HY PM OBI CBR OR N LE P C EE38 FRm r = mpg. m ELL 3 D . PAT 00- -8,OC88 oP. BAC"3C00L m . CmL8-n B R"=
.
R-8"W
38
E88
0 0 PTCER
AS R
- RIPORT
m
m_
8-T
88 0
LV 2 9 26, 2 9 2 , 2004, - 5 0-m A3 0 W C Tlu " violated W rules of probation in that " == , " 26 2004 r 0 ED laV8 8P C=nc -33 S3 0 LAFOL C W P AT W n EmE W RE W ru oo of probation inthat i HAVB That i vio " ated lns To3D R 3 -3. m To coE 3 -P 30m8 8- TO D0 80. D S 8 9 3 6 7 0, That viol ted MY ruleB of probetion ln that ctt m8 6 7, `, DAY J3Y 2004 = 22 25 26 27, 28 2004 C mED BY tt 3Y tt T 2 rN" To A D 9 5 2004 That vio ated MY ruleo of probation in that T 3Y mPS 9 200` F TO D ABD That violated MY ruleg of probation in that o -7 3V 0- A3 PM 8-LV 7 2004 TO V d ppb tioc h ttt ON t = o atod C P 0-" T08-03-R To ATTHD 2 9 26. 2004 rH th ln tht -7 = o of mat etOd D3Y"C C C T violated MY rules of pr bation in 200`, 7, 2004 7-D"MP
J
hnt
to dnd ASSISTaNT
s
a013,PIlr3 1
o,o
thll
ll
:11
ll
li
1 ,
::
` i
.11
Identity Documents
= = = =
-2-
Fl
: r lT
mttA TE
ATA
A [
trffbadl&
.{$
,.sd
21 SEP
" 1'33
tt
HousTo
e,an 25 J
=
8484144630 EX8809210F1302251
Birth Certificate
l
2
NAME:
P:ace: BIRTH:
KAREN
(first)
MATA
(midd le)
NA ARRETE
(bS0
MEXICO SAN AVIER ttLALNEPANttLA MEX:CO (city or town) (state or province) (country)
SEPTEMBER 21,1988 (mOnth) (day)(year)
Datei
FATHER'S NAME:
RAUL
MIRANDA
(middle)
NAVARREttE
(last)
(lrSt)
4
5
MOttHER'S NAMEI
CER lFICATE ISSUED:
9,1995
MARIA ROSAR!O
(lrSt)
GUERRERO
aSt)
MATA
(middle)
ANUARY Date:
Magistrate:
6
Placei
TLALNEPANTLA
MEX!CO
MEXICO
Certlficate No C1721987
CURP 1510401880619
NOTAT10NS OFIMPORTANCE:
CERTIFICATE OF TRANSLATORiS COMPETENCE
certify that the above is an accurate translation of the "birth certificate" in Spanish and that lam competent in both English and original Spanish to render such translation.
Date
of Bernardo Eureste Ennio Diaz,Attorney at Law,5615 Richmond Avenue,Suite 250,Houston,Texas 77057 713-581-7051;832-436-1733:info@houstOn_da com
::11111:
Puttyl
: IYt==
01
=
t n
EIIA,MARTINEZ IEON:
Marriage Certificate
L`
r %
rli2.
.
`
7 7 , t " , z Z %z , " % % t
`
"
tt
Z
rtt PJ
J`
Davin OneaT ilones and Karen .llavarret,e-I{aEa
%=
:
(2 t tt r/. a ` ` 02,40 ,2
a (%
3.,"
%
`
55 2Ztt
]
,25 2
77 5
2007; has Five Years of Continuous Residence in the United States Since June 15, 2007; and has resided in the United States since March 6, 1995 to the Present
MiSCELANEOUS DOCUMENttS
From
05/28/1997 o
12/16/12
RQ6L022A S:
FS:0377178378
77015
KAREN NA ARREttE
Gnnc Annorr
Attorney General
Si necesita asistencia para leer esta carta, por favor llame al nfnrero: (800)252-8014
e
O
tlle total alllount collccted durillg a full service period(See l10te below)
ho v lllllCh Ofthc total lvas sent to yOur fainily
how much oftlle total was kept by dle State Note:This repays the State for fces o ved or TANIF paytnellts( velfare beneats)
you rcceivcd in thc past
PAYOR NA lE
CASE
CAUSE
PROCESS
DATE
PAYMENT
DATE OF
RECEIVED
AMOUNr
$()0()
]1/13/12 11/13/12
11/26/12
11/2('/12
11/13/12
W
W W
3000
$4807 $5769
TOTALS
See b k raddittdilfOm lon)
$12s.00
$10s.
NOTE: Afull sentice period is whel you are receiving full child support enforcement services by the Child Support Division.
Federal The letters i1 t5e payrnelt Type colunur clescribe which payruents lvere received. The letter "I'stands for IRS intercept received. after paynents days for 120 holds such Division Child Support days. the to 180 larv pennits states to hold r"rtuil m3 intercepts for up for other "R" is eruployer. by the obligor's payrnents withheld "W' stands for is reieived. collection the wtich iu the last 6ay of the month interest that payrne,ts ieceived frorn the obligor. "F" is for payments applied to attorney and/or genetic testing fees. Arrears include arty
may have accrued on the case/cause.
Fonn 6L022
Septeriber 2010
HARRiSHEALTH
SYSTEM
P,O BOX 203736 HOUS ON,TX 77216-3736
Statement
AccountNumber: 965009691092
Reference Number: 33566089 Amount Due: $209.15 Office Hours (Eastern Time Zone) MONDAY - FRIDAY 8:00 AM EST - 5:00 PM EST
Date: Patient:
December 19,2012
NAVARRETE, KAREN
7
:::::::
::::il:l:l:ll:111::ll:::::11:l::::i::l::illl:::
J
DeAT KAREN NAVARRETE,
and/or clinics Thank you for being among the many Harris County residents who receive their healthcare at one of the hospitals to a provider, forward look we and your healthcare to call ourselves within the Harris Health syitem. lt is an honor to bb able long relationship with You. statement to you as a Besides, thanking you for being one of our valuable patients and satisfied customers, we are sending this you disagree with this information friendly ieminOer tnat you havjan unpaid account balance that needs your attention. lf (800) 726-0514. you can call in error, nbtice this you received have and/oiyou believe
address. In When paying by check, we would ask that you make it payable to Harris Health System and mail it to the below you to add your that like to request also would System order to avoio detays witn tne processing oi your payment, Harris Health account number (as listed above) on your check.
delays. Finally, we would like to thank yorlin advance for making this payment without any further
I
.1 1
. k
] P lARttN l l A[
LMHCl
Please detach and return bottom portion with your payment
REMiT TO:
965009691092
:1
UNT$
511 L5 L L L LttLq L
ll
Bankof America
Bank of America,N_A P_0.Box 25118
Tamptt FL,3622 5118
COmbined Statement
Page
11 08
of
6860098826
Statement Period
B05 0 APPA 6
12 through 12 07 12
::::::ll::::lll:::ll::llllll::llllllll::!:!
2/18 0,1 02 MD
3 2 8
1::::II:::i15:1323
Banhing service allows you to eheck balances, track account activity and. more' Our -Wi;[ O"tirr" --- Online banking yoo r". also view up-to 18 months of this statement online and e-ven turn off delivery of your paper statement. Enroll at www'bankofamerica.com.
586009882620 586009877745
12
07
12-07
2.70 14.31
Totalamount due
$
8812
AnnBTTENERGY
Account A2995064
invoice 244D9 5
b SSR:
ri : $
Amount enclosed $
tfditfsstrrm
'Total amomt due"
Karen Navarrete ,
Ambit Energy
P.O. Box 66O462 Dallas, TX 752ffi-M62
Houston, 77915
ll
5 L
I
,
llll D l
Please mail this portion with your payment Make check payable to: Ambit Energy, Keep this part for your
records.
AnnBTTENERGY
PUC License:10117 Customer Care: 87
282 6248
Statement Date:
11 119112
Due Date:12/05/12
eWardS prOgram summary
Polnts earned this month:678
Total pOints tO date:11,716
Customer name: Karen Navarrete Valued customer since: 11/@/11 Account number: A2995064
lnvoice number:2MD9J5
Centelpolnt at(800)332-7143
Account Summary
Previous balance Payments received -- Thank youl Prior period miscellaneous adjustmentb Balance forward
For more information about residential electric l, service, please visit www. powerto c h o o se. c d *h
',il
I
$ $ $ $
9602
(8722)
18801
0 CICl
lmportant Messages
See page 2 for additionalimportant ,
messa9es
Cunent Ambit Energy charges Centerpoint Charges Taxes and other fees Cunent miscellaneous adjustments Cunent charges due by 1AO5/12
$
$ $ $ $
7345
Account Details
Houston, TX 77015
ES D:l
ofl
3439
ND FMAMJJASON
Current Charges
Ambit Energy Charges
Customer Charge
.
6346 999
Page l of3
NON PAYMENT
CE TO VACATE FOR NO
OF REW,UTILHIESOR Om SUMs
December 7 20 2
Date
50
No [ t
7?p15
5-/
Rc
Notice to vacate for non-payment of renl utiiities or other sums
Eouston. llX
,State,zipD
TAAbaseCoubactdated As on contract
between residssts named abov5 atrd
rc$E
allocatedorsubmeteredrdilities,
are
,tr
ltl.eUy made. You are hereby givon aotice to vacate the dwelliag on or before mirtnight, the tO day it ' this of Aegenber as (four delivery of uotice aoted below the one day from least which is at , 2Ol2 , days if the notice was mailed). Your failure to move out the,t will result ia appropriate legal adion by us before the Justice of the
o*
.ightr.
in
the
1
the method checked below
Thenotice
was: (checkat
lAtt
one)
residents namcd above; , hand delivered to any person 16 or older residing iu the dwelliug;
handdeliveredtoanyoneofthe
'
sent by sent by
keyld
lr
AnnerrrNERGY
Account:A2995064 :nvoice:244D9
5
Total amount
due
Amount enclosed $
Karen Navarrete 550 Normandy St Apt 25'12 Houston, fX77015
Plee
make
Enqgy
t-*7
D
'
Dallas, TX
752m 046'
5 L
ll
008115
00] 00
.\-
Pl6ae mail this pqtion wth your payrent. Make c*r@k payable to: Amtit E@gy.
K@p this pad
ld ytr eqds.
AnnerrENERG Y.
December 06,2012 Dear Karen,
We know how busy life can get, That's why we're letting you know that your Ambit Energy invoice listed ab' past due. You can avoid service disconnection on 12118120'12 by making sure we receive your payment of $. your cunent charges by 12t17t2012. Once a disconnect order is sent, you are subiect to a disconnect fee of $
$40.00 reinstatemenl fee plus applicable Transmission Distribution Utility (TDU) fees and taxes.
The fastest way to make a payment is through your online account at our secure sile: www.ambitenerov.com. You c-.. reach our Customer Care Team by calling (877) 282-6248, Monday through Friday from 8:00 a.m. to 6:00 p.m. and Saturday from 1O:00 a.m. to 5:00 p.m. cT. For additional payment options, please see the back of this letter. Please note that payment of the 'Amt. Required To Avoid Disconnect' on this notice may not prevent disconnection of your service if any prior invoice has past due charges. lf your service is disconnected and you would like Ambit to reinstate it, Ambit may cancel your current plan and continue yotrr service under the Ambit Standard Energy Plan. lf you are ill or need assistance paying your bill by the due date, call Ambit Energy Customer Care at (877) 282-6248 lo diicuss an altemate payment anangement, deferred payment plan or possible payment assistance from state or federal
agencies. lf a deposit is on record, it will be applied toward the final bill with any remaining deposit returned to you. lf you fail to make a satisfactory payment or enter into a payment anangement with Ambit Energy, we will use various methods to attempt collection of payment, including use of consumer reporting agencies, debt collection agencies, small claims court and/or other remedies allowed by law. Any inquiries regarding this notification should be refened to Ambit Energy Customer Care. lf yo_u are not satisfied with our response to your inquiry or complainl, you may file 9 complaint by calling or writing the Public Utility Commission of Texas, P,O. Box 13326, Austin, TX, 78711-3326, at (512) 936-7120 or toll-free in Texas at (885) 782-8477 . Hearing and speech-impaired individuals with text telephones may contact the Commission al (512) 936-7136. Complaints may be filed online at www.puc.state.tx.us/ocpicomplaints/complain.cfm. Thank you for your prompt attention. lf you have recently paid your bill, please disregard this notice. PUC License 101 17
AD 1206
11
Statement Date:11/19/12
PUC License:
.10.1
Due Date:12/05/12
17
Gustomer Carez
(84
6PMandSat
IOAMto5PMCT
l,i lll
lr'
'i,i
,
Delivery Rate lncrease Transmission Distribution Surcharges Advanced Metering Energy Efficiency Cost Recovery Hun lke Restoration Chg Hunicane lke ADFIT
10/17-11/15 Factor
$ $
$
221
Charge Credit
305
102
0192 (0.23)
O.gZ
Charges
$ $
$
$ $
013
001 0.14
Miscellaneous Adiustments
Current Miscellaneous Adjustments
Late Pavment
Penaltv
Adiustments
$ $
$
3.97
S.SZ
(11301
$
$
250
{8.801
Page 3 of 3
u i
1/1/2012 1/1/2012
1 1
Rent(01/201
Sewer(01/2012) Water(01/2012)
Trash(01/2012)
1/1/2012
1/1
ng Fees(01/2014
l
1/9/2012
1/9
Pd
on
tl7lt2
7924 80500 71300 1044 522 500 276 7000 2000 1000 72300 9000 276 500 995 1989
chk#37230 420
Rent(o2/2q12) sewer (0212012)
water(p
2012)
Trash(02/2012)
Bil ng Fees(02 2012)
3/1/2012 3/1/2012
3/1
Rent(03/2012)
Remainder of late fee for Feb Reimbursed other Reimbursed Trash - 2 Reimbursed Water - 2 Reimbursed Sewer - 2
2012
69775 71125 1800 72300 72576 80500 000 71300 72344 72866 73366 73642 80642 82642 83642 55942 64942 65218
2012
3/1/2012
3/12 2012
chk#406530502 chk#445641033
changed locks
chk
84000 9000
2500
3/12/2012 3/12/2012
3 12
14467008800
ctrt* rqadzooegol
chk
2012
32603'1878
3/26/2012
4/1 2012
chk#14490565945 chk,14490566234
Rent(05/2012)
Reimbursed Sewer Re mbursed Trash Reimbursed Water
2012 2012
1/2012 3/2012
5/1
5
chk#14477838907
Rent(06/2012)
Reimbursed Sewer Reimbursed Trash Reimbursed water
6/1/2012
6/1 2012
6
1/2012
6/1/2012
6/2 2012 6/5 2012
chk# 14524b80032
chk#1152488016
Rent(07/2012)
Reimbursed Sewer Reimbursed Trash
/1/2012
7/1/2012 7/1/2012
026 72326 74326 5102 76102 3802 76102 78102 8878 79878 6878 2978 75278 77278 8054
34984110 35075736 35075961 35076183 35076405 35119665 35138044 35151216 35586585 294 356 35746257 35746258 35746259 35746260 23293613 23293646 35778690 23446226 23446231 23446392 35893803 36206889 36435182 36435183 36435184 23657603 23787838 36843560 36962344 36962345 36962346 23984566
3749993
37615742
37615 43
37615744 24249288
24325797
https://voyager.myriverstone.com/voyager60/reports/Resident-L...
9l13l20l2
Lcdger
Reimbursed Water 10.00
6 V
790.
7/5/2012
7
Late Fees
pald late
60.00
9.46
9/2012
7/9/2012 8/1/2012 8/1/2012 8/1/2012 8/1/2012 8/4/2012 9/1/2012 9/1/2012 9/1/2012 9/1/2012 9/4/2012 9/13/2012
chk#386380228
Rent(08/2012) Re:mbursed Sewer
Reimbursed Trash
723.00 20.00
.76
Reim[urse$ Water
12.30
20.00
Reimbursed Trash Reimbursed Water 7.76 10.00
18.06
38341134 38368952 24654725 38839023 38969589 38969590 38969591 24937699 39389595 39389596 39389597
3959286
Rent(09/2012)
723.00 140.00
chk#549009827
Auqust Late
2527081C
39772085
https://voyager.myriverstone. com/voyager60/reports/Resident L.
I 13 12012
Vi:ia Sierra
Billing Date:
Unit: Account #: Move in Date: Balance Forward:
02/12/2011
S16262
Tota:Due:
(!f pald by 12/01/2012)
s925.04 check#:
Amount Paid:
Villa Sierra
550 Normandy Street Houston, TX 77015-3598
:::
::
::11::::111]:]lllill:113:lli:::::llli!::llll:::
til;ltr;l,,,lrr;l,iltllhhtllllltll,rlllt,lrtrllllilillll'['111
n t19 upper
Property Fees
$723.00
New Charges
$762.42
Balance Fonruard
$162.62
Total Due
Date Due
12 01
$925.04
Villa Sierra
2012
Unit 2512
CHARGE DEttAILS
Outstanding Charges:
Rent Past Due Balance
$16262 $16262
Rock reek
Property Fees:
Rent
iIli111lli[]llililll:`11
RUBS:l Unl X l1 65922619
y bo Sa ng
RUBS:2 0ccupant X 0
Sewer Base A ocation(09/24-10/23)
RUBS:l Unl X 20
Sew,r Exp Occupant A ocation(09/2410/28)
RUBSi2 0ccupant X 0
Trash Coilecuon Charge(09/2410/2o)
Flat Charge
* Residenl utility charges are generaled by RockCreek, 40OO lnternational Pkwy Ste
1000 Carrollton, TX 75OOT . These chargellare allocated from masler property bills received by the property from lhe resppctivgr utility provider. This bill is not from Cily of Houston. Charges are allocated to iesidents based upon lheir lease agreemenls. For delail on rate calculalions, refer to your resident porlal or conlact lhe properlys management staff. Property Fees reflect data in the resident ledger as of the dale bills were printed and mailed. You are responsible for paying the correct amount in a limely manner. Please contacl your leasing oflice to rePorl any errors or
omissions.
RPV 100
For questions regarding your account,p!ease contact Customer Service Number at(866)4857485 10:T010:002161:001:1000:10782124:MSVGH 0000:0001:RPV100
(p ld
Service Details
Con
Account Number
Billing Date
8777701260367032
11/19/12
Unpaid Balance
New Charges Total Amount Due
$121.53-Due Now
$7877-Due 12 09/12
$20030
d ua
"wW
mtadtom ,
l o XttMTY
Page 2 of2
FCC Regulatory
Fee
0.08 $8.79
and$hargel
Digital'Adapter Service
000
11/24-12/23
$61.49
Adapter Service
additiona1 0utlet
otal
XFINITY TV
$8.49
State Franchise
Fee
077
461
1 il i:
FS1 0375346626
Ccntral File Mailltellancc
R, L022A
SI
+ AUTO =
5-DIGIT 7701 5
'
48146 1 AV 0 350
ia
4
lll:::l:ll::::i:llll`::113::ll!ll::: ::l
GnBc
Assorr
AttorlleY Getleral
Si necesita asistettcia para lecr esta carta' per- ft :t<lr* l! nr::e o! n{rnrcro: (:it}l})2i2-{}{l 1'{
sllo\\'s: repon sl.tou's: records l lre report o,,r r".orat-fne lbr r lour You may want to kecp this letter t-r . the total arlount collected cluring a full service Period (See uote below ) . hor,v tnuch ofthe total rvas sent to vour farnily . horv rnuch of t1e totui ,ui,, kept by the State. I'lote: This repays the State for fees owed or TANF payments (well'are beneltts) you received in the past.
()()12:
10/01/12 10/22/12
10/01/12 10/22/12
00:2301'1)7
$5769
0012301907
TOTALS
(See back for additiollal infonllation)
srzs.0o
s"ts.o
NoTE:
A/itll
.f services by the Child Support Division' seniceperiod i{rvhen you are receiving full child support enforcernetrt iltJ
Federal payruent, *"..: r":..ly"d rhe letter "r'stands for IRS intercept received The letters in tle payneut Tlpe colunur describe which days after payrrents for 120 sucrr holds Division Support child lg0 ;ays rng larv pennits states to trota .ertor,r IRS i,tercepts f", "w'stands lbr paynents rvithhetd by^the obligor's emploler' "R" is for other received. is collection the u,hich i, mo*th of the clay the last ..F,'is for palmelts applied to attonley aud/or geuetic testing fees. Arrears include any interest that payrneuts received frour the obligor. inay have accnted ou the case/cause'
Sepl.rnber 2010
HA5E
Account Number
000000994261782
Nole: Ensure your checkbook reglster is up to date with all lransactions to dale whether lhey are included on your
slatemenl or not.
liWlis statement: Wi : :: :T I:
Date Amounl Date Amount Date
Step l Baiance: $
Amount
Total: $_
S
Step l otai:
List and total all checks, ATM wlthdrawals, debit card purchases and other wlthdrawals nol shown on this statement.
Check Number or
Date
Amount
Amount
Step 4
Total:
-$
5. Subtract
Step 4 Total lrom Step 3 Total. Thls should match your Checkbook
Balance:
$-
lN CASE OF ERRORS OR OUESTIONS ABOUT YOUR ELECTRONIC FUNDS TBANSFERS:Call or write us at the phone number or address on
the front ol this statement (non-personal accounls conlacl Cuslomer Service) il you lhink your statement or receipt is incorrect or if you need more infornration about a transler listed on the stalement or receipt. We musl hear from you no later than 60 days alter we sent you the FIRST statement on which the problem or error appeared. Be prepared lo give us the following information: Your name and accourlt number The dollar amounl ol the suspected error A description ol lhe error or transfer you are unsure of, why you believe it is an error, or why you need more informalion. We will investigate y6ur complaint and will correct any error promptly. ll we lake more lhan.10 business days (or 20 husiness days for new accountslto do this, we will c;edit your account lor lhe amount you lhink is in error so lhat you will have use of lhe money during the lime it takes us to complete our investigalion.
. . .
lN CASE OF ERRORS OR QUESTIONS ABOUT NON-ELECTEONIC TRANSACTIONS:ConIaoI the bank immediately if your statement is incorrecl or if you need more inlormation about any non-electronic transactions (checks or deposits) on this statement. ll any such
appears, you inusl notity the bank in writing no laler than 30 days afler the statemenl was mado available lo you. For more complete dbiails, s6e the Accouni Bules and'Regulalions or olher applicable account agreement that govems your account.
error
il
Page 3 ol 4
:Al f LN l AIEl ll
10
Ul
$0.00
$209.15
11 t
$142.00 $142.00
$0.00 $0.00 $0.00 $0.00
buC
CLINIC
a 11111
LABORATORY
lnsurance Payments and Adiustmentsi
Payment Total:
Adiustment ttotal:
ity:
$142.00
-$10400
$33.00 $71.00
$0.00 $38.00
2012 CASH
03/04 2012
Adiustment
2 :l :t ::] :I l
PO.Box 203735
HoustOn,TX 77216-3735 (713)566-6600
$24715
Page Number 1/2
15L
::::
JL lil=1
I: :0
4U:ZI
100406287
I
llllllill:l=`::llllli::::
i::l:llllll :::lllllll::ll::
MESSAGES
Hards County Hospttal Dlst ctis now
F2
DESCRIPT:ON
Ac 6 nti 066009614012 I L6 11111:ST 1 RRY : 10J17 2o1211111 IClls, 101VTPATI NI Total Charges Billed:
1
ltatement eas9"
71 566-6ooO.
IS at
$1,047.00
` `
ity:
Oystem HII
l l
10/17/2012 CASH
10
26/2012 Adiustment
-$799.85
Please check boX if above address is incorrect and indicate change(s)On reverse side
You rnay pay your b
l
CARD NUMBER
S:GNATURE
l
Make checks, money orders payable and mail payments to: Harris Health SYstem
=AM00N
01=INOW
GUARANTOR NUMBER
STATEMENT DATE
11 16/2012
$247.15
100406287
l1715L LI ll L L LLLL 7L L
AMBITENERGY
Account A2995064
invoice 207Al 7
Totalamount due S
Amount due r pad after due date $
To ass t other Texans h paylng thdr unity b
s,
96.02
10056
box. $
ffdilfermtfrm
Total amomt dre'
Amount enclosed $
Karen Navarrete
DO NOT PAY
The - amount due will be charged to your credit card 1 day Prior to your due date.
q 5 L
LI
7A 7
l 5L
Please rnail this portion with your payment. Make check payable to
AnnBtr
EN ERG Y
+
l
Due Date:11/07/12
Rewards program summary
Points eamed this month:664
Total points to date:11,038
PUC cense:10117
Customer Care:18771282-6248
Hours Of Operatlon:Mon
F",8 AM to
& 1
Account Summary
' ' I
Previous balance
10575
111
See page 2 foraddtionllimpOnant
Payments received -- Thank You! Balance forward Cunent Ambit Energy chargas Centerpoint Charges Taxes and other fees Cunent miscellaneous adjustments Cunent charges due bY 11/07/12
$ (105751
$
$ $ $ $
0 716
messages
Account DetailS
Houston,TX 77015-3439 ES
1
Di
ES D:l
ofl
The average price you paid for electric service this month is $0.'118 per kwh. See page 2 for more information average price t
II
1
ONDJFMAMJJASO
Gurrent Gharges
Ambit Energy Charges
Energy Charge (29 days, 664
about calculation
',1
kwh
$0.0936)
6215
Page 1 of 3
Due Date:11/07/12
10.1
17
6PMandSat l0AMto5PMCT
.Effective August 1 2012, the Public , Utility Commission of Texas (PUCT) imposed a 50% increase to the priQe cag for wholesale power generation, thfreQy'f increasing the cost to secure energly fdr your account. Per your Terms of Service i [OS), costs resulting from a rule change may be recovered from customers. Ambit Energy will recover the related costs for August 2O12 by assessing fixed rate plan customers with a Power Cost Becovery Factor (PCRfl. The PCRF will appear as a line item on three consecutive monthly statements. For more information, please contact Ambit Customer Care at (877) 282-6248 Monday - Friday, B:00 a.m. to 6:00 p.m., or Saturday 10:00 a.m. - 5:00
219 305
102
Transmission Distribution Surcharges Advanced Metering Charge Energy Efficiency C,ost Recovery Factor Hun lke Restoration Chg Hunicane lke ADFI-I Credit
110
10201
7.16
.PowerCostRecoveryFactorS/1
-8/31
014
001
tl.za
11.43
90.73
pm.CT
iscellaneous Adiustments
529
5.29
Page 3 of 3
HHSC
P.0.BOX 15100
MIDLAND ttX 79711-5100
r'?TTEXAS
bi('!1"*ig##,T,?1,,,
Date
l1/05/2012
Case Number:1012822789
ca
1-877-541-7905
98' oo
9602S300 W STE A
Sandy UT 34070 3301
Comcasl
RET RN
SERViCE REOuESTED
Total Balance:912163
!:.,1,1!1,ll,1.l..: ,,,!!l.1.ll[.lIl11.11!:11..:[111'
:
,
KAREN NAVARRETE
@omcost
"Please clisregard this notice jt you have already made payment. ,, Dear Karen Navanele, Your Comcasl accounl is now past due in lhe amounl ol $54.4 t, and our altFmpls to co ect peymenl iave been unsuccesstul lf we do nol recerve payment by I l/04/12. your Comiasl services wilibe suspended on or shortty afler Ihis date, and ydu wilt be c6a8ed rec;i0ection teiJto iesiore your
q -.:pended. we.must.receive payment by 12l06/i2 or your accounl wi be fu y 9l!:-ry11-r_"!o!!1 orsconneded on or strorlty afler lhis dele lf your servrce is ,ully disconnect;d, payment of lhe lolal Darancp due ptus appticable reconneclron fees will be iequned pnor lo scheduling ieconnection of your
Comcast High Speed lnternet Customers: lf service is flrlly disconnecled, you may te required lo eslablish 5 new emeil address Dlgital_Voige-Customers: tt your account iq suspended, yolt wjfl onty be abte to diet 9t I for emergency servrccs and til I to reach our billing deparlmenl. lt may take up to 24 hourS aner vour oavment ,r no{;.| ro rsrore vou, oigirarvoice service tIvour account rs iurry drsi-onnected you wittio.eitri aorriiv rrioiii9r I ror emergency services and 6r r rf paymenr is received afler youf accbunr has been drsconnecred, yorrr cuflent pnone number may no tonger be avarlable, end you mey receive a new phone number Customers: tf.your services are suspended, yor, wi no tonger be mondored Burqtar, ll:Te:9:u-rity ' ||rc or-mpdtl.er atarm signats wifl nol be sent lo lhe app,oprialF emergency resfonders and you will be cnargeo a rPactrvatron ree tn order to teslarl your.account l, your serviccs ara tF,mrneted, will be iou requ|led to pay lo Comcast lhe eariy termrnaiio fep ptease lee your SuOscriber eqriemeht tor more rniofinarion on lhe eariy lerminerion ,ee To rernslale service, youwi be requned ldepply lor service as a new cuslomer. and you wilt be subiecl to att instalation and actrvetion charies To avoid interauption or disconnection of service, please do one otthe tollowingl A) Pey online al !vww.comps!-com, where you {ran set up hasste-free aulomaled monthty paymenls or pay your ball by month lt's convenient. tt's free, and it is avajtabte when you are! 8) Use our always evaalable aulomaled system by calting 1-800 COMCAST (1-000_266_2278) where you c8n pey your bitlby using your credit ordebit card you can atso havd Comcasl procdss an eleclronic payment right from your checking or savtngs accounl Comcasl teteDh;ne represenlalives are avaitable to process payments loi a one-trme transaclion lee C) Visit one of our Comcast Cble stores. you can find all Comcasl Stores closest lo you al
!!44.Sq0!e{!q0.
D) Visit any Weslern Union location acrcss the couotry to pey your Comcast bill. E) firarl your check or money order to. PO Box 660618, Da as. TX 75266-0610. Please allow 7 days for mailed peymenls lo aI,ive and posl lo yout accounl Please nole: Fairure ro utrr,,e one of the payment oplions above may resuft in service inlerruplron or diqconnecl
Sincerely,
Comcesi Cable
communications
7 days to arrive and post
to your
account.
9872,TH2PRFS0 273
KAREN NAVARRETE
550 NORMANDY ST APT 25,2 HOuSTON TX 77015 3439
Account#:87777 1260367062
Tota!Balance:$12153
Amount Pa d$
COmcasl
PO BOx 660618
Da as
::`1,:
Tx 75266-0018
ll,,,
Use lhis coupon to mail your check or money oader. You may also call us loll free al 1-800 COMCAST (1-800,2662278) to meke a peymenl wilh your Visa
1,l,,,!l1ll!,,,,1::111,11,,,,,l:,,lt,,,1111,I
CCOmCO,t
87777[,12LO L70L 01 15
l 1 111 1
FS:0373389969
AUS N,TX Ccntral Fllc Maintenance
P O BOX 12048
78711-2048
AU 0
5-DiG!T77015
33881 l AV 0 350
Gnsc Annorr
Attorney General
Si necesita asistencia para leer esta carta, por favor llame al nfmero: (800)252-8014
IBER
how mllch oftlle to l was kept by the State Note:Ths pays the State for fees owed or TAblF paylnents(
you received in tlle past
Vel re benents)
PAYOR NAME
CASE#
CAUSE
PROCESS
DATE
PAVMENT
DATE OF
RECEIVED
AMOUNT
JOnlES
0012301907 0012301907
201067934
201067934
09/04/12 09/17/12
09/04/12 09/17/12
W W
S5769 $5769
$5769
$57.69
$000
JONES
$000
TOTALS
(See back for additional Llfomation.)
Sl15.38
may havc accrued on the case/causc
Septurbs 2010
lll
:
Fon 6L022
1ht
Harns county HoSptal DistnctiS now Harris Health System
:GUARANTOR NUMBER
PAYITHiS I
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500.
Houston, X77216-3735
Page Numbe
15
l:ll:lillil::l:::lllllllllllll::
:lll:lillllllllililil::llllll
For questions related to Baylor College of Medicine, Please call 71 3-798-1 900.
MESSAGES
DESCRIPT:ON
Piease check bOX if above address is incorrect and indicate change(s)On reverse side.
You rnay pay your bill.
MOUNT
PAID
Make checks, money orders payable and mail payments to: Harris Health SYstem
XP
DATE
100EINOW
GUARANTOR NUMBER
STATEMENT DATE
10 25
$38.00
100406287
2012
7 LI L L 7 5 L 7L L
AnnBITENERGY
Account:A2995064
invoice:207Al 7
Karen Navarrete l
7ALJ7
5 L LI
i
I
.\-
Please mail this portion with your payment. Make check payable to: Ambit Energy,
recorcls.
AnnBITENERGY
November 08,2012
Dear Karen,
We know how busy life can get. That's why we're letting you know that your Ambit Energy invoice listed above for $96.02 is past due. you can avoid seriice disconneition on 1 1t2Oi2O12 by making sure we receive your payment of $96-02 to cover your current charges by l1l1gt2Q12. Once a disconnect order is sent, you are subject to a disconnect fee of $15.00, a Utility (TDU)fees and taxes. $+O.OO reinstatement fbe plus,af,plicable Transmission Distribution
can reach The fastest way to make a pi$m,int is through your online account at our secure site: www.ambitenergv.com. You from p.m. Saturday and 8:00 a.m. to 6:00 from Friday through Monday (877) 282-6248, by'daqing Team our Customer Care .10:00 a.m. to S:00 p.m. Ct.lfor'additional payment options, please see the back of this letter.
t ,i
please note that payment of the 'Amt. Required To Avoid Disconnect' on this notice may not prevent disconnection of your it, service if any prior invoice has past due charges. lf your service is disconnected and you would like Ambit to reinstate Plan. Energy standard Ambit the your service under ;i"uivou current plan and continue
A2995064
207Al 7
ffi;''t;ry
(877) 282-6248 to lf you are ill or need assistance paying your bill by the due date, call Ambit Energy Customer Care at payment from state or federal possible assistance plan or payment deferred discuss an alternate payment to ybu. lf you fail returned "ri"ng"r"nt, deposit any remaining billwith final towird the applied ajencies. lf a deposii i" on recgro, ii wiil be methods to various we will use Energy, Ambit with arrangement a'payment into to make a satisfactory pryr"nd or enter claims court small agencies, collection debt agencies, reporting of'consumer use attempt collection of payment, including jio*udlby Energy Customer to Ambit be referred should notification this regarding inquiries Any law. and/or other remedi"! *ltn or, r"r[on"" to your inquiry or complaint, you may_file a complaint by calling or writing the care. lf you are not ""tirri"o public uiitity commission of Texas, P.o. Box 13326, Austin, Tx,78711-3326, at (512) 936-7120 or toll-free in Texas at the Commission at (512) (ggg) 7g2-g477. Hearing and speeih-impaired individuals with text telephones may contact Thank you for your prompt ranrnr.puc.state.tx.us/ocp/complaints/complain.cfm. 936-7136. Complaints riay ue iited online 61 notice' this please disregard attention. lf you'have recently paid your bill, PUC Licens e
10117 I
I
il
AD 1206
@omcost""
Con
Account Number
Billing Date
8777701260367062
10/19/12 $54.41
Unpaid Balance
New Charges
Due Now
$6712-Due l1/08/12
$121 53 Page l of2
TotalAmount Due
00XttMTY
Karen Navarrete
For servico
al:
10029 -4588
TX77o15-3439 r, l'.'
6712
$121.53
54.41
TotalAmount
Due
<(!'
MTY TV
Other Charges & Credits Taxes, Surcharges & Fees Total New Charges
51.11
843 758
$67,12
Li:.O$hill '
ever. Also available are automatic t!onthly payments so you'll never need checks, stamps ol envelopes again. register today. Visit www.corncast.com/srppolt More information regarding oul ratqb is ' available on our website www Comcast.com or you can call us at 1-800-XFINITY (1-800-934:
',iIf
.t
648e).
Detach and enclose this coupon with your payment. Please write youriccount number on your check or money order. Do not send cash,
@*.ost
9602S300VV STE B SANDY UT 3)070 3302
8777 7000 NO RP 19 10202012 YYNNNYNN 01 01X1071
550 NORMANDY ST APT 2512 HOUSTON}TX 77015-3439 Make checks payable to Comcast
KAREN NAVARRETE
00MCAST
PO BOX 660618
DALLAS TX 75266 0618
111:llll:::l:::llll!::lll!lll:::::lllll::::::::::::
77770L L L7 L L 15
Ap11 2010
HHSC M!DLAND
tr*hrEXAS
bir'!l:llli*#ffil.^
CASE NO/APP NO: 1q12s227s9 Call: 2-1-1 toll-ftee (lf you can't connect, call 1-877-541-7905). Eax: 1 -87 7 -4 47-2839 toll-free. t\rtail: llHSC, P.O. Box 14700, Midland, TX79711-4700
lf you are deaf, hard of hearing, or speech impaired, you can call any number by calling 7-1-1 or 1-80G735-2989.
DATE:10/13/2012
]
lnterview Notice
To flnd outif you can get benentsl we musttalk with you about your case
lnten
iew Date:11/o5/2012,Monday
Time:10:oo AM
lfyou miss this viSl,your benents might be DELAYttD pastthe end ofthe month or you might not get benefits. To set up another visit call toll-free 2-1-1 or 1-877-541-7905 as soon as you can. Your beneflts will end if we don't hear from you.
The benefits you are renewing have a check mark next to them:
SNAP Food Benefits TANF Cash Assistance
Health Care
worsen or fail
PER:ODIC PREVENT
PhySiCian, eam
Memeber Service[AMI
Page 3 of 3
Navarrete,Karen(MR#037o494
C)rd 10
HiV 1 HiV
10/17/2012
c6htlnued
2D:AGNOST:C/SYMPTOMATiC
MediCation Reconciliatio
Refills
O.1 I
tablet
desogestrel-eth inyl
Prescription i
s e-Prescribed
r
'
'l
3/3
Dosage
Take l tablet by rnouth da
y.
,12541012, g: 99 1011et
:: I %T
:
10/17/201211:31 AM
: : ll ::i:lpr X:
12/4/201212:00PM IT8P91
BRAASTAD,WILttAM DENttST
1
:
::TRAWBERRY I
Don't feel well or have a question regarding your health? Call ASK MY NURSE!
,
Before scheduling an appointment, callthe ask my nurse line. Available 24 hours a daVi 17 days a week' available to all HCHD patients'
Thank you for choosing Strawberry Health Center and have a healthy day' The AVS and medication reponciliation form was given to the patient' Maria Banda, LVN 120152 il
713-982-5900
1
rl
ff
i
Page 2 of 3
Navarrete,Karen(MR#037849472)
Encounter Date:10/17
2012
HARR:S COUNTY
HOSPIttAL DiSTRICT
Date&Time
AM
10/17/201210:20
Depanment
St Family Practice
Dept Phone
713 982-5900
MD
ViSitlnhmmn 0
Vistt and
Patient lnformation
Depanment
St Family Practice
Encounter# 58657452
MD
Patient
Demographics
Phone
832 748.3874(HOme)
Address navarrete-karen
E ma
yahoo.com
832-748 3874(MOb e)
A ergies
as of
10/17/2012
Date
w
i
Aller
Noted
10/17/2012
Type
Reactions
:10/17/2012
ViSl Summary
Diagnoses
Orders
Orders
GLUCOqE, FASTING LIPID PRbFILE HIV.l /HIV.2 DIAGNOSTIC/SYMPTOMATIC CHLAM/GC DNA AMPLI wET MOUNT
PAP SMEAR KOH STA\N
FCXq
vAbctNe rDAP VACCINE >7lM ;ili.'i;iAlitls, orpineRla, rceltuLAR PERrussls vAcclNE IN cLINlc
Page 1 of 3
HA5E
PMorgan
Chase Bank,NA
Account Number
000000994261782
CUSTOMER SERViCEINFORMAT10N
00095765 1 AV O.35
111 11
ll
l
1111
1ll
1:l
lllllllllll
1:ll
1lllllll
lll!
1
TT
KAREN MAttA
1 ooooooooo
1 oooo
NAVARRETE
Web sile: Service Cenler rss2ssT P196Eo Deal and Hard of Hearing. Para Espanol: lnternalional Calls:
l 800 935
1
Chase.com 9935
800-242-7383 1-877-312-4273
1-713 262 1679
You will see more information about your ATM deposits on your account statemenl. Tracking your ATM deposils will be even easier beginning November 12, 2012. ln the Depositi and Additions section ol your statement, you will see the date you made your deposit (in addition to the date we posted it to your account) and the last lour digits of the card'number lor each ATM deposit. You will see lhese changes on all ATM deposits that post to your account on and alter November 12. Please note that any ATM deposit
transactions that post to your account belore November 12,2012 will not show this additional inlormation and willnot be included in the ATM & Debit Card Summary section at the end ol your slatemenl. ll you have questions, please call us at the number on this stalement or visit your nearest branch.
I
CHECK:NG S
Beginning Balance
Deposits and Additions
45751
30309
$154.42
408286163
4082861,99
Page 1 ol 4
Ha s
-1
1/2
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500.
IIli:l:" l::lii:
5
lll::l: :1llill:lllll::Hill11:Illlill
For questions related to Baylor College of Medicine, please call 71 3-798-1 900.
MESSAGES
Harris County Hospital District is now
DESCR:PT10N
Tota!Charges Billed:
S14200
$142.00
$0.00
LABORATORY
$000
$0.00 $0.00 -$142.00 -$104.00 -$33.00
Office hours: M-F 8:00 a.m. - 4:30 P.m. lf you have any questions after office hours, you can e-mail us at customerservice@harrishealth.org
Financial assistance may be available. Call us today to learn more. , Sincerely, Harris Health System
2012 CASH
03 04/2012
Adiustment
-$7100
3ARD NUMBER
SIGNATURE
V2
AMOUNT PAID EXP DATE
Make checks, money orders payable and mail payments to: Harris Health SYstem
IAM00NT101 INOW:
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
10/03/2012
7 11 LI L L 1 L 7L L
Comcasl 9602S300 VV
Sandy UT 34070
l![1:.1:[.[[lill....,,,,111.!.lllll,:[.:,.!.111111.11.l.
KAREN NAVARRETE
@omcost
"Please disregard this notice it you have already made payment. .. Dear Karen Navenele. Your Comcasl accounl is now pasl due in the amount ot 545 88. and our allempls lo collect paymenl have becn unsuccesslul. l, we do nor receive payment by t0/05/12. your ComdeJ services iitibe sl.rspnded on or shorlly afler this dale, and you will be charged recoineclion fees lo restore your
Once your account is suspended, we musl receive pgyment by 11/06/12 or your accounl wi be fu y djsconnecled on orshorlly afler lhis dale. lfyourservice ls fully disconnectad. pavment oflhetolalbalance due plus appliceble reconnection fees willbe required prior lo sched u ting ieconnection of your
Comclst High Sped lntemet Custooers: lf service is Iully disconnected, you may be required to eslablish a new email address. DigilalVoice CuslofteE: lf your accounl ts suspended, you willonty be ebte lo dial911 for emergency serurces and 611 lo reach our brlfing clepartmenl ll may take up to 24 hours afler your payment rs-post6d lo reslore your Digilel Voice servrc lf_you, account rs fully disconnected. you wtt lose ihe abitity to diat 9llforemergencyservicesand5ll It payment is received afler your accounl hes been disconiecled. your current phone number may no longer be availgble, nd you may receive s new phone number. Home Securily Custorners: lf your services ere suspended, you will no longer be monilored. Burglar, fire or medicel alarm ggnals wll nol be senl lo the appropriale emergency responders, end you wll-be charged a reaclrvaton lee tn order lo reslart your account. ll your services are terminaled. iou wi be required lo pay lo Comcasl the early lermination Iee. Please see your Subscflber Aoreement for more informalion on lhe early lermrnation lee To reilstate service. you yyill be requtrFd to apply fot service as a new cuslomer, and you wll be subject to all inslatlalion and aclivation charges To avoid interruption or disconnection ot service, please do one otthe following: Pay Omne comca ,om whec you or pay yOu bili by month it s convenient t.sl : ml ]my paymems
C)MSl=:
% TCa.Ca
e ores
D ! :, lW % ? Pttr )
:1
S ncere
1mportant: Ma ed payment may take up t0 7 days to arive and pOstt our account P h12
lt
KAREN NAVARRETE
550 NORMANDY ST APT 2512 HOuSTON TX 77015 3439
Date:September30 2012
Account":0777701260067 62 Total Balance:S`0029
Amount Paid s_
Comcasl
PO Bo 660018
Da as TX 75266
0018
11
free at l 300
COMCAST (1-800
266
11,,,l,I,l,,i:,l,11,,1:l,,11,,,,11,t,,
@omcost
87777 lPL 70L20 Oa 7
An BITENERGY
Account:A2995064 invoice:163ElD8
10575
Amount enclosed
Karen Navarrete
Houston,TX 77015
Please make payment to: Ambl Energy P O Box 660462 Dallas,T 75266-0462
5 L
ll
LL ELD8
L 575
.\-
Ptease mail this ponion with your payment. Make check payable to: Ambit Energy.
AMBITENERGY
October 09,2012
Dear Karen,
Account Number: lnvoice Number: Billing Date: Past Due: Amt. Required to Avoid Disconnect:
Due Date:
A2995064 163ElD8
09/21/2012
$10575
$105.75
10/19/2012 10/22/2012
Disconnect Date:
We know how busy life can get. That's why we're letting you know that your Ambit Energy invoice listed above for $105.75 is past due. You can avoid service disconnection on 1012212012 by making sure we receive your payment of $105.75 to cover your current charges by 1011912012. Once a disconnect order is sent, you are subject to a disconnect fee of $15.00, a $40.00 reinstatement fee plus applicable Transmission Distribution Utility (TDU) fees and taxes.
The fastest way to make a payment is through your online account at our secure site: www.ambitenergy.com. You can reach our Customer Care Team by calling (877) 282-6248, Monday through Friday from B:00 a.m. to 6:00 p.m. and Saturday from 10:00 a.m. to 5:00 p.m. CT. For additional payment options, please see the back of this letter. Please note that payment of the 'Amt. Required To Avoid Disconnect' on this notice may not prevent disconnection of your service if any prior invoice has past due charges. lf your service is disconnected and you would like Ambit to reinstate it, Ambit may cancel your current plan and continue your service under the Ambit Standard Energy Plan.
lf you are ill or need assistance paying your bill by the due date, call Ambit Energy Customer Care at (877) 282-6248 fo discuss an alternate payment arrangement, deferred payment plan or possible payment assistance from state or federal agencies. lf a deposit is on record, it will be applied toward the final bill with any remaining deposit returned to you. lf you fail to make a satisfactory payment or enter into a payment arrangement with Ambit Energy, we will use various methods to attempt collection of payment, including use of consumer reporting agencies, debt collection agencies, small claims court and/or other remedies allowed by law. Any inquiries regarding this notification should be referred to Ambit Energy Customer Care, lf you are not satisfied with our response to your inquiry or complaint, you may file a complaint by calling or writing the Pubtic Utility Commission of Texas, P.O. Box 13326, Austin, fX,78711-3326, at (512) 936-7120 or toll-free in Texas at (BBS) 782-8477. Hearing and speech-impaired individuals with text telephones may contact the Commission at (512) 936-7136. Complaints may be filed online at unruw.puc.state.tx.us/ocp/complaints/complain.cfm. Thank you for your prompt attention. lf you have recently paid your bill, please disregard this notice.
PUC License 10117
AD.1206
C>mCOSII
Cottad
Acceunt Number
Billing Date
8777701260367062
09/19/12
545.88
Unpaid Balance
New Charges Total Amount Due
Due Now
$54.41-Due 10/09/12
$10029
wtOmcadtom
00X MTY
Page l of4
Karen Navarrete
For service
Previous Balance
Payment
I
at:
4588 000
45.88
5441 $100129
TotalAmount Due
MTY
TV
prepayment of a deposit,restart feel and ttrst month:s payment tthere is a charge fo a unreturned equipment Save tlme SaVe a tree Your entire statementis
available online Sign up today for secure online billing and say goodbye to your paper bill fo
Other Charges & Credits Taxes, Surcharges & Fees Total New Charges
::
:!t
:
ever Also ava able are automatic monthly payments so you:li never need checkS,Stamps o envelopes again
6489)
tl: : ::
:ve t
Detach and enciose this cOupon wlth your payment Please w ite your account number on you check or money order Do notsend cash
@r.ost
9602S300VV SANDY UT 84070 3340
8777 70011 NO RP 19 09202012 YNNNNYNN 01 000092 0
)1
KAREN NAVARRETE
1 1,
I
Make checks Payabie to Comcast
:!:!lllll::111111111:lllllll111111:::l`::ll
COMCAST
PO BOX 660618 DALLAS TX 75266 0613
111:::;
lllll::'ll:::::::!::ll`:::`
L 87777 L L L7 L
ttD
17
fr1
Gorcost.
8777 7000 NO RP 19 092112012 YNNNNYNN 01 00 920001
Account Number
Billing Date
8777701260367062
09/19/12
$45.88
Unpaid Balance
New Charges Total Amount Due
Due Now
$10029
Page 3 of4
COMCAST PRiCEINFORMAT:ON
Houston,TX
Dear Valued Customer;
l .II
August,2012
$1295
. .
.
Price
New Price
$1495
S 1795
$ 1 99 ea
HD/DVR Service.... , .
. . $ 1695
Not
. .
.3 000
Fastest lnternet Speeds + Most Comprehensive Security = The Best 0nline Experience
37949
3102.99
Sl16 99
o . .
*
XFINITY is the fastest lnternet service in Houston with download speeds up to an incredible 105 MbPS. XFINITY delivers reliably fast lnternet-over 100% of its advertised speeds-even during peak use hours.* So you get the speed you need for a great online experience on all your devices. Comprehensive online protection with Constant Guard, including Norton Security, at no extra charge
Price
New Price
$ 025
$ 020
Price
New Price
2012
'
. .,S13995 .. Preferred XF Triple Play Bundle,_` $14995 HD Preferred XF Triple Play Bundlo . I. . ...... . S15995 HD Preferred Plus XF Trlple Piay Bundle . $17995 HD Premier XF Triple Play 8undle .. $20995 HD Complete XF Triple Play Bundle , . $23995
S14495 $154.95
S16495
$18495
$21495 S24495
And with the Comcast Custonlel;Guarantee, we promise to provide you a consistently superior experidnfe, ihcluding 24l7 customer service, two-hour appointment windowshnll on-time arrival-or we'll credit you $20 or give you a free premium'chdnnellor three months.
Price
New Price
,$8485 mOnth)
$89,85
While we continue to make these and other investments, we periodically need to adjust prices due to increases i4 programming and other business costs. Starting 0ctober 1,2012, new piices will apply to certain video and lnternet services and equipment as indicated in this notice. lf you are currently receiving services on a promotional basis, under a minimum term agreement associated with a specific rate, or in the guaranteed period of one of our SurePricerM plans, the prices for those specific services will not be affected during the applicable promotion, minimum term or SurePricerM period.
CurrentPrice New.Price
Performance Wth XFINITY TV or Voice Service
8hst!
$61.95
$ 5195
lf you have not yet experienced the value of bundling all of your entertainment and communications services with Comcast, we'd welcome the opportunity t0 help you Iind the perfect package that meets your needs. Visit us at xfinity.com
or call us at 1-877-395-5385 t0 learn pore.
Thanks for being a Comcast customer. We bok lorward to conthuing to serve you.
Certain services available separately or as a part of other levels of service. Service is subject to Comcast's standard terms and conditions of service. Unless otherwise specified, prices shown are the monthly charge for the corrosponding service, equipment or package. Prices shown are for residential service only and do not include federal, state and local taxes, FCC user and franchise fees or Regulatory Recovory fees or other related costs, and are subject to change. Not all services
Bajc .
1 $2499
r
$2736
lf you are a video service customer and you own a compatible digital convertor or CableCARD devlce, please call l-800-XFINITY for pricing informatlon or visit ww.comcast.com/equipmentpolicy. After a notice of an Increase in rates, you may change your level of service at no additional charge for a period of 30 days from the effective date of the change. 0therwise, a fee may apply. lf you have any questions, please contact us at 1-877-395-5385 or 8590 West Tidwell, Houston, TX 77040.
are available in all areas.
SA7CF06U
HA5
PMorgan
Chase Bank,NA
Account Numbo
000000994261732
CUSTOMER SERViCEINFORMAT10N
o0036577 1 AV 0 35
:lll
lll l===::
web snei
Servioe Centeri Para Espano
1nternational Ca
ChaSe com
l 300 93'9935
ll:=::::1lll!`=:ll==!:11:llill:::1:==:::!!!:ll X
1-800-242-7383
'110000T711994P16005
1-877-312-4273
l-713-262-1679
T_
S178
19700
7616
Sl19 06
DESCRIPT10N
AMOuNT
o9/1l
09/18
Depos1
Depos1
402012,77-_
396402776 __
OATE
09/11
09/1l
09/11
DESCRIPT10N Card Purchase With Pin 09/11 Family Thrift Center - Houslon TX Card 1913 12620 Woodfores Houston TX Card 1913 Card Purchase W h Pin 09/11
ATM VV hdrawal
AMOuNT
09/11 13706 East Fwy Houston TX Card 1913 44592 Houston TX Card 1913 1'l Starbucks O9112 Card Purchase 640 Houston TX Card 1913 09/12 Card Purchase Wnh Pin o9/12 oe Vts 2
0 13
o9/13
0913
09712 Redbox Dvd Renta1 0akbrkterrace lL Card 1913 0912 Redbox Dvd Renta1 0akbrkterrace lL Card 1913 12620 Woodfo oS Houston TX Card 1913
0918
Card Purchaso Wlh Pin 09/18 Wa Mart StOre HoustOn TX Card 1913
MC:E
RQ6L022A Sl
I : I
FSi 0370944227
Ccntral File raintcnance
P O BOX 12048
AUSTIN,TX 787H-2048
5-DiGIT 7701 5
GREG ABBoTT
Attorney General
l::
:]111111:lilll`3`lli:::ll:11: ::::
:31ililil
Si necesita asistencia para leer esta carta, por favor llame al numero: (800)252-8014
le molldl ofAl'GUST
WE ARE GIVING T S TO YOU FOR YOllR INFORDIAT10N.YOU DO NOT HAVE TO TAKE ANY ACT10N.
You may vant to kecp tllis letter fbr your rccOrds I hc report shows: the total alnollnt collected d ng a in service pcHod(Sce nOte below) how inuch ofale total was scllt to your farllily 1low mucll ofthe total was kept by lle State Not ]his repays ule s te for fces owed or T2 paylllents(wel re belleits)
you received ill dle past
PAYOR NA lE
CASE
CAUSE
PROCESS
DATE
PAYMENT
DATE OF
RECEIVED
AMOUNr
JOhlES
0012301907
201067934
08/20/12
08/20/12
$5769
$5769
SO.00
TOTALS
(SCe back fOr additional infol natioll)
S57.69 1
SO.
NOTE:
Afiill
semice periut is when you are receiving full child support enforcement services by the Child Support Division.
The letters in the Payment Type column describe which payments were received. The letter "f'stands for IRS intercept received. Federal law permits states to hold certain IRS intercepts for up to 180 days. The Child Support Division holds such payments for 120 days after the last day of the month in which the collection is received. "W' stands for payments withheld by the obligor's employer. "R" is for other payments received from the obligor. "F" is for payments applied to attorney and/or genetic testing fees. Arrears include any interest that rnay have accrued on the casey'causeSeptember 2010
Fonn 6L022
HealthPortrM
VISITOR
09 13
201211:39 AM
lnner, please lnclude the
'
Dear Pa
1
Karen Navarrete
No Pic
ln orde
lollowin
a a
Registrar
Accelerated Center
lf the parient is unable to sign;
o o
Provide Durable Medical Power of Attomey with letter from physician stating the
patient is mentallY incomPetent. lf the patient is competenl but unable to come to the hospital, the patienl can wrile a letter releasing the records to an individual. The patient's signature will be verified by signature in patients chart.
o Authorizalion must be signed by surviving spouse listed on death certificate in raddition to the medical chart. q lf no surviving spouse, provide Executor of Estate documentation
,tl
I
''l
There is a Oharge for copies of the medical records. The fee is .25 cent3 per page. Should you need the records for continued care, we will be glad to fax them directly to the physician's office at
no charge to you. You should expect to receive your requested copies in the mail within 7-10 days.
Feel free to contact Healthport at 855-519-9682 if you have any questions or if you would like to
discuss in greater detail. We appreciate your patience.
Sincerely,
1
1 1
:L: `
Ln
:L
:I
`'7
V I
iGUARANTOR NUMBER i
100406287
l2
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500. For questions related to Baylor Collbge of Medicine,
8000000a?0
llllltllll!l1ltrlt1,,;,l,ll1',1111'llll1"l11lll'l'111'l'l'1'!11'
KAREN NAVARRETE 'I 550 NORMANDY ST AbT ZSIZ HOUSTON, TX 77015-'3439
please call
7 13-7 98-1
900.
MESSAGES
Harris County Hospital District is novr' Harris Health SYstem
DESCRIPT10N
Dear KAREN NAVARRETE, Thank you for choosing Harris Health System for your healthcare needs.
lf you have questions about this statement, please call us at 71 3-566-6600.
Total Charges Bilied:
$142.00 $142.00
$0.00
LABORATORY
customerservice@harrishealth.ord,
$142.00
-$104.00
more. '
27/2012 CASH
$33.00
Sincerely,
L
03/04/2012 Adiustment
-$71.00
CARD NUMBER
SIGNATURE
ltl=INewi AMO
Make checks, money orders payable and mail payments to: Harris Health SYstem
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
09/11/2012
7 L LL L 87L L
AnnBITENERG Y
Account A2995064
Total amount
due
date
$
$
148.27
15543
invoice l16AlA2
To assist other Texans in paying their utility bills, enter your donation and check the box.
$
$
r dfForeni frOm
stal
arnount due"
.
Karen Navarrete
Amount enclosed
Please make payment to:
Amblt - Energy
701, Houdon,
1
/ Lb
5 L
LI
LLLALA
LI
5 LI
payable to: Arnbit Energy Please mail tlris ponion with your payment Make check Keep this part lor Your records.
\05
\b51 t
Due Date:09/07/12
Rewards program summary
Points earned this monthi 851 Total points to date:9,438
AnnBtTENERGY
PUC Ucense: 10117
Customer name: Karen Navarrete Valued customer since: 11/08/11 Account number: A2995064 lnvoice number: I1641A2
6PMandSat 10AMto5PMCT
To report a power outage or emergency, please cdl Cer rierpoirrt at (8O0) 3J2- r t43
Account Summary
I
Previous balance Payments received -- Thank youl Prior period miscellaneous adiustments Balance forward Current Ambit Energy charges Centerpoint Charges Taxes and other fees Current miscellaneous adjustments Current charges dueby O9/O7/12
$
S
16695
(20883)
$
$
250
139.38)
Messages
"f
'
You are cunently enrolled in a paym6nt plan. Your second installment of $45.73 is due on 9/5/2012. See page 2 for additional important messages.
$ $ $ $
$
$
514
18765
148.27
45.73
Account Details
Houston, TX 77015 3439
ES D:l
ofl
ESID
Gurrent Charges
Ambit Energy Charges
Energy Charge (29 days, 851 kwh @ $0.0936)
309
l
1
Term End Date:05/13/13
7965
Page
.l
of 3
2040
::
006
8P
.424
_Tl11
::::li,I :
HouSTON TX 77015
111
Requesting unit: o0000 Dear VaIued Customer, Enclosed are the coples you rscsntly requested'
mone than To Bxpsdlts the processlng of your requestr YoU may recelYe your ordet' comPlete psckage to ong
If you have any questlons, please caII tho numbsr Itsted on vour bank stalement to speak wlth one of our customeF servlce rsPrsssntatlves'
Thank you for chooslng Bank of Amerlca'
Account
TYPe
DDA
Item Type;
04
Account Number:
586007949824
FEBO,
MAR09
APRO,
MAYO'
JINO;,IU109 1AUO19
12 Statement Date1 08
Customer Name:Karen Navarete Account Number:A2995064
1nvoice Number l16AlA2
Fn,8 AM to
Due Date:09/07 12
6 PM and Sd 10AMto5 PM CT
I
Customer Charge Disconnect Fee Payment Plan Fee Reconnect Fee
999 1500
20.00
Total Ambit Energy Charges Genterpoint TDU Delivery Gharges Delivery Rate lncrease 7/19-8/17
Transmission Distribution Surcharges Advanced Metering Charge
Energy Efficiency
$ $
S $ $
5000
174.64
235 305
102 143 (025)
$
$
7.60
001
182.51
026
0.27
iscellaneous Adiustments
514
5.14
Fee
$ _ Adiustments $
2.5o 2-50
Pa99 3 of3
AnnBlr
Account:A2995064
EN ERGY
invoice: 116AlA2
10254
5 L
LI
LLLALA
L 5
iS Please ma
An BITENERGY
September 10,2012
Dear Karen,
A2995064 116AlA2
08/22/2012
$102.52 $102.52
09/20/2012 09/21/2012
We know how busy life can get. That's why we're letting you know that your Ambit Energy invoice listed above for $102.54 is past due. You cin avoid service disconnection on 0912112012 by making sure we receive your payment of $102.52 to cover your current charges by 0912012012. Once a disconnect order is sent, you are subject to a disconnect fee of $15.00, a 950.00 reinstatement fee plus applicable Transmission Distribution Utility (TDU)fees and taxes.
The fastest way to make a payment is through your online account at our secure site: www.ambitenergy.com. You can reach our Customer Care Team by calling (877) 282-6248, Monday through Friday from B:00 a.m. to 6:00 p.m. and Saturday from 10:00 a.m. to 5:00 p.m. CT. For additional payment options, please see the back of this letter. Please note that payment of the "Amt. Required To Avoid Disconnect" on this notice may not prevent disconnection of your service if any prior invoice has past due charges. lf your service is disconnected and you would like Ambit to reinstate it, Ambit may cancel your current plan and continue your service under the Ambit Standard Energy Plan. lf you are ill or need assistance paying your bill by the due date, call Ambit Energy Customer Care at (877) 282-6248Io discuss an alternate payment arrangement, deferred payment plan or possible payment assistance from state or federal agencies. lf a deposit is on record, it will be applied toward the final bill with any remaining deposit returned to you. lf you fail to make a satisfactory payment or enter into a payment arrangement with Ambit Energy, we will use various methods to attempt collection of payment, including use of consumer reporting agencies, debt collection agencies, small claims court and/oi other remedies allowed by law. Any inquiries regarding this notification should be referred to Ambit Energy Customer Care. lf you are not satisfied with our response to your inquiry or complaint, you may file a complaint by calling or writing the pubtic Utitity Commission of Texas, P.O. Box 13326, Austin, TX,78711-3326, at(512)936-7120 ortoll-free in Texas at (BB8) 782-8477. Hearing and speech-impaired individuals with text telephones may contact the Commission at (512) 936-7136. Complaints may be filed online at www.puc.state.tx.us/ocp/complaints/complain.cfm . Thank you for your prompt attention. lf you have recently paid your bill, please disregard this notice. PUC License 10117
AD.1206
] II :: I]::
FSi 0368927192
Ccll(ral Filc Maintcnallcc
P O BOX 12048
DIGIT 77015
45365,AV 0 050
GREG AB30TT
Atlor:ley ccllcral
dlc l
10nth Of
tJl
. .
how much ofthe total-$'as seut to )our fornilv payuerts (welfare betreftts) iiow iiruch of the total \,os kept by the State. Note: This repays the St&te for fees o\r'ed or TANF you received ir the past.
[:: PA ORN
CASE
C, SE
ROCESS
DA E
D TE
OF
lENT PA
RECEIVED
A 10UN
JONES
JON S
(,012301907 ()012301907
201067934
2()167,34
()
)2/12
()7/02/12
W W
$000
$00()
l
07/16/12
07/3()/12
07/16/12 07/30/12
JONES
0012301907
201067,34
1807
TOTALS
(SCC bact rOr add ional lllfonllado
)
S125.Oll i
S48.0
NOTE:A/1
lnay have accrued on the case/cause
0
sCl pcnod is wlEllyou a"rccciving fl11l chlld support cnfOrcclncnt scrviccs by the Child Support Division
8927192
ll
6 Street. 1717
F
r512,232-0638
AugustL3,2Ot2
I ,i
t
rj
we hope you are doing welll we want to thank you again for agreeing to participate in Project cHolcES pt us. we are pleased to have you as a participant. Your continued participation in this project can help
provide meaningful information that may assist others' interview. This is a 5-10 Today, we are writing to remind you about an upcoming 6 month follow-up will be contacting you by minute follow-up session which will be conducted over the telephone. we phone over the next few days to schedule this interview'
'
time/day you would prefer lf your phone number has changed since your initial interview, or you have a foi us to call, or you have any questions about the study, you may contact us to let us know at L-877294-H BRT (427 8l o r email hbrt.choicespl us @austi n' utexas'edu'
1
Thank you again for youf participation in this very important study.
,1,
||, ,[
;'
Sincerely,
I'
rl
'
4.
Dr.Mary Marden Veiasquez
S Director of Prolect CHOICES P
AnnBtr
Account
2995064
ENERG
Total amount
due
date
$
$
x'
Tot
17222
invoice 077DOH7
To assist other Texans in paying their utility bills, enter your donation and check the box.
Amount enclosed $
Karen Navarrete
Please rnake paymentto: Ambl Energy
d fferent
Houston,TX 770151
q5
L ll
77D H7
LLL 5
Please mail thrs ponion with your payrnent. Make check payable to: Ambit Energy' Keep this part for your records.
AMBITENERGY
PUC License: 1 01 1 7
Due Date:08/03/12
Rewards program summary
Points earned this month:1,011
Total pOints to date:8,587
AM to
6 PM and Sat 10 AM to 5 PM CT
To report a power outage or emergency, please call C-enterpoini at (800) 332-7143
Account Summary.
Previous balance Payments received -- Thank You! Prior period miscellaneous adjustments Balance forward
;
For more information about residential electric r service, please www. powe rtochoose. co ITI i'
$ $
$ $ $ $
$
10888 5888
9463 802
visit
$ (52.501 S 250
t,i ,';
Current Arnbit Energy charges Centerpoint Charges Taxes and other fees Current miscellaneous adjustments Current charges due by O8/OB/12
017
525 10807
58.
ES D:l
166.95
Accouht Details
Houston,TX 77015 3439
1500
l CK
ofl
ESID
alo
JASONDJFMAMJJ
The average price you paid for electric service this month is $O.tO1 per kWh. See, page 2 for more information about t average price calculation
Current Charges
Ambit Energy Charges
Energy Charge (30 days, 1,01 1
kwh
$0.0936)
9463
94.63
Page l of3
8 27
2012
550
Houston TX.
Dear (
g a Yourp sent e ms
Ta
zttd.
When our lease is renewed, your new rental rate for your apartment will be C0 . lf you choose to go on a month to month lease, your new rental rate will be S__ L L= 26L+$150.00 per month.
We would like to schedule an appointment with you to discuss your lease renewal. You can reach us a1(J13\ 451-2142. For your convenience, our office is open seven days a week. We ask that you come to the office by 812712012 to finalize your decision in writing. Please remember that we may also be reached via email at vi llasierra@riverstoneres.com.
*Remember, if moving, you must give a 60 day notice to vacate in writing even you are on a mgn,th to month lease.
I
if
lf a one-year renevlal is not possible at this time, we do offer a select number of shorter limited basis at variable rates. term options onI t ll
t'
Vitta Sierra Apaidinbnts is committed to maintaining a pleasant living environment for all
of our resident$. lf'you have suggestions or comments, please feel free to telephone me or stop by the leasing office.
Renew before 8/29/2012 and Enter into a Drawino to Win a Flat Scr?en T.V. on Thursdav 8/30/2012.
Thank you for your continued residency and for making Villa Sierra Apartments not just a place to live, but Q place to call home.
Sincerely,
:31d
P.O Box 203735
Houston, X77216-3735
JL
100406287
Page Number:1/2
lll::lllllil:=:lll:lll:'lillllllilillllllll:l:illli:ll:lilillllil
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500. For questions related to Baylor College of Mediclne,
MESSAGES
please call
71
F2
DESCR:PT:ON
$142.00 $142.00
$0.00
LABORATORY
lnsurance Payments and Adiustments:
Payment Total: Adlustment Total:
Transferred to Patient Responsibility:
2012 CASH
03/04/2012 Adiustment
$71.00
AMOUNT PAID
EXP DATE
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
07/27/2012
7 L 7 7 7 L 87L L
Villa Sierra
550 Normandy Street
Billing Date:
Unit:
07/24/2012
Unit 2512
RI VSA2012042512
Houston,TX 77015
02/12/2011
$000
000163010627840
laymen
d;
: 11
V :a Sierra
Houston, X77015-3598
llll::]]illllllll":::IillH::1:il
:::lllill:!llillll!l
H: :::: llli:ill:::lilllll::ll:
l:":::
::llli::
lll
For proper credl,p!ease detach and rlturn thl llper pOnion wlh your payment Thank yOu
New Charges
S763.06
Balance Fonruard
$0.00
Total Due
S4006
S763.06
unit 2512
CHARGE DETAILS
Property Fees: Rent Scheduled Property Fees Due
llRocklreek
Utility Charges and Property Chargei: Water Base Allocation (05/1 9-06/1 5)r
RUBS: 1 Untt X12.2991O714 r, Water Exp occupant Allocation (0b/1'9-06/15) RUBS:2Occupant XO Sewer Base Allocation (05/1 9-06/1 5) RUBS: Unit X20 Sewer Exp Occupant Allocation (05/1 9-06/15)
fi
uessacE BoARD
COmpO
vegda e bod wade
S000
$2000 $000 S500
g 8 R: lmgV e :S
Property Message
c 1
Water Conservation
e s300
RUBS.2Occupant X0
Trash Collection Charge (05/19-06/1 5) Flat Charge Trash Admin. Fee (05/19-06/15) Flat Charge
Utilty Charges and Property charges Due
S276
S4006
S763.06
" Resident utilily charges are generaled by RockCreek' 4000 lnternational Pkwy Ste 1000 Carrolllon, TX 75007. These charges are allocaled from master property bills received by lhe property from the respeclive ulility provider. This bill is not from City o[ Houslon. Charges are allocated to residents based upon their lease agreements. For detail on rate calculations, refer lo your residenl porlal or contact the property's managemenl staff, Property Fees reflect data in the resident ledger as of the date bills were prinled and mailed. You are responsible for paying the correcl amount in a timely manner. Please conlact your leSsing.office to report any errors or omissions.
RPV 100
For questions regarding your account,please contact Management at(713)451 2142 (QESP)10:T013:003968:001:1000 10753032:MSVGxx000010001:RPV-100
An BITENERGY
Account A2995064
Invoice 103H2B41
Totalamount
due
$
1
1
date $
4' 13
enteryourdonationanicrrecxtnloox'
$ _-__=_- E
Amount enclosed
Karen Navarrete 550 NormandY St APt 2512
Please make payment to:
$
Ambl Energy
Total
P O Box 660462
Dallas, D
75266-0462
Houston, TXt77015
1 5
L LI
H L
tt B LI L
LLI L
payable to: Arnbit Energy' Please rnail this portion with yotrr payment Make check Keep this part Jor Your records.
8:'7 b
AnnBtTENERG
PUC License:10117
Customer Care:18771282-6248
Hours of Operationi MOn
F
,8 AM to
6 PM and Sd 10 AMto5 PM CT
:l1
For rnore infor nation
Account Summary
Previous balance
$
$
8165
(8415)
service,piease visit
www.powertochoOseocom
Payments received -- Thank You! Prior period miscellaneous adjustments Balance forward Current Ambit Energy charges Centerpoint Charges Taxes and other fees Current miscellaneous adjustments Cunent charges due bY 07/09/1 2
$ $ $
250 000
$ $
$
818 017
9660
393
$
$ $
10888
108.88 0.00
Account Details
ES D:l
ofi
1 1
1 Current Plan: Lone Star Select - 12 Month Term Plan
JJASCNDJFMAMJ
The average price you paid for electric service this month is $0.t0.1 per kWh. See page 2 for more informbtion about average price calculation
Gurrent Gharges
Ambit Energy Charges
Energy Charge (32 days, 1,032
kwh
$0.0936) 96.60
Page 1 of 3
[
100406287
PAY THIS
NT
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500.
:::il
NttPT
HOUSTON
lilli:lil!l:::::ll:::::: :lllilllll111
For questions related to Baylor College of Medicine, please call 71 3-798-1 900.
X77015-3439
MESSAGES
DeaT KAREN NAVARRETE,
DESCR:PT:ON
:A 001
011tiOIIIISTIRAWBIEIRRYl11 75'34
`=1300
$142.00
LABORATORY
$14200 $000
$0.00 $0.00
ty:
at
CustomerService@hchd.tmc.edu.
$142.00
-$104.00
Sincerely,
: I
02/27/2012 CASH
03/04/2012 Adiustment
$33.00
-$71.00
By PhOne at(713)566-6600
CARD NUMBER
SIGNATURE
AMOt'N=lbllEINOWI
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
07/05/2012
ll L 7L 7 5 7 L L
HA5E
PMor9an
Account Number
000000994261782
P O Box 659754
San Antoni ,TX
00 27615
1:
1 AV O.35
00127615 DRE 201 143 20012 NNNNNNNNNNN T 1 000000000 11 0000 T577933 P12969
TT
KAREN MATA NAVARREttE
]
1
11:ll.ll11
l11 !:11
llllllli
Web site: Service Center: Deaf and Hard ol Hearing: Para Espanol: lnternalional Calls:
AMOUNT
Beginning Balance
Deposits and Addllions
$4.02
18100
- 18254 $2.48
DATE
06/26 06/26
DESCR:PT10N
AMOUNT
DeDOSit
Deposit
10595551
1059555
s12100 6000
$181.00
DATE
AMOUNT
DESCRIPTION
06/19
Card Pur<;hase
12620 Woodfores HoustOn TX Card 1913 06/19 Card Purchase Wlh Pin o6/19 OOT2O Subway 00431015 Houston TX Card 1913 06127 Card Purchase Store#2995 Houston TX Card 1913 wlh Ph 06/27 Jcpenney Store#2995 Houston iX Card 1913 06/27 Card Pu hase '',
__Vulu l ulv::
=r==rT, === ==== 06/28= Comcast of =__= Houston 713-341-1000 TX Card 1913
rr
06/28
06/28
06/28
Card Purchase
06/27 Circket Wireless Pasadena TX Card 1913 06/28 13378 Woodlorest Blvd Cloverleaf TX Card 1913
ATM WIhdrawal
Card Purchase Wlh Pin 06/28 Valero 2213 Houston ttX Card 1913
Page 1 ol 2
d
P O Box 203735 Houston:TX 77216-3735 Page Numbe 1/2
ll
GUARANttOR NUMBER
100406287
PAY THIS
Physician services may be billed separately. For questions related to University of Texas, please call 7 13-500-3500. For questions related to Baylor College of Medicine, please call 71 3-798-1 900.
L7
:i:llllillilill:lil:l :l:lll::lilililllllilll :::l::l:l:::
80 PT 2 W
HOUSTON,TX 77015-3439
MESSAGES
Dear KAREN NAVARRETE, Thank you for choosing Harris County
Hospital District for your healthcare needs.
IAIII
DESCRIPT10N ntl161117719341
LoO=tiOI:iSTIRAWB=IRRY
$142.00 $142.00
3-566-6600.
LABORAttORY
lnsurance Payments and Adiustments:
Payment Total: Adiustment Total:
Transferred to Palent RespOnsibility:
Pa ent Payment and Adiustments:
02 27
$000 $000
$0.00 $0.00
CustomerService@hchd.tmc.edu.
$14200
-$104.00
Sincerely,
i]
2012 CASH
$33.00
03 04/2012
AdiuStment
-$71.00
AMOUNT PAID
CARD NUMBER
SIGNATURE
ID IAM00 EI OW
EXP DATE
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
06/13/2012
LI L 7 7L LL L 5 L
Christian Tabernacle
Touching lesus, Touching You
13334 Wa isv le
Rd.
713-453-7000 713-453-1617
www.ctab.org
Page
1
ui 10,2012
'1
1::il
111
: 2 2
Houstor),TX 77015
Mid Year contributions for the year 2012, for which you received no persr:nal benefit except tor intangible religious services.
D31e
l
Ck#
ru 1 2
Ttthes
342012
oreang 1000
Bldg Fund
Missions
l-ocal Out
Min. Supp.
Other
otal Contr
1000
3..1 F
4 1 4
2000
2000
17
2012 2012
5/27/2012
6/10 2012
6/17/2012
24/2012
7800
7800
lf you have any questions or comments concerning your statement, please contact Marshall coble at (713)453-7000 ert.244
AnnBITENERGY
Account:A2995064 1nvoice:103H2B41
10888
Karen Navarrete t
'.
L
H
tt B LI L
5 L
OnwnhyOurpa
To
O Am Ene9y
AnnBtTENERG
uly 10,2012 Dear Karen,
A2995064 103H2B41
06/22/2012
your Ambit Energy invoice listed above for $108.88 We know how busy life can get. That's why we're letting you know that sure we receive your payment of $108.88 to by making is past due. you can avoid slruige disconnectio n on oilzltzol2 you are subject to a disconnect fee of $15.00, a sent, is order yo* current charges by Olt2Ol2O12. Once a disconnect (TDU) fees and taxes. Utility Distribution "or", $50.06 reinstatement fee plui applicable Transmission www.ambitenerqv.com. You can reach The fastest way to make a pajl-nent is through your online account at our secure site: a.m. to 6:00 p.m. and saturday from our customer Care Team by ihtting (8771282-6248, Monday through Friday from B:00 this letter. 10:00 a.m. to 5:00 p.m. CT.-[or ddditional payment options, please see the back of
please note that payment of the,"Amt. Required To Avoid Disconnect" on this notice may not prevent disconnection of your you would like Ambit to reinstate it, service if any prior invoice has past due charges. lf your service is disconnected and Energy Plan. Standard Ambit the your under service Ambit may clncel your current plan and continue
Customer Care at (877) 282-6248 to lf you are ill or need assistance paying your bill by the due date, call Ambit Energy payment possible assistance from state or federal plan payment or deferred diicuss an alternate payment arrangement, deposit returned to you. lf you fail remaining any bill with final the toward applied be ii will record, agencies. lf a deposii is on methods to to"make a satisfactory payment'or enter into a payment arrangement with Ambit Energy, we will use various claims court small agencies, attempt collection of payment, including use of consumer reporting agencies, debt collection Customer Energy to Ambit be should referred and/oi other remedies allowed py law. Any inquiries regarding this notification the or writing you calling a complaint by file may complaint, Care. lf you are not satisfied wiin our response to your inquiry or Texas at (512) in 936-7120 or toll-free at TX,78711-3326, public uiitity Commission of Texas, P.O. Box 13326, Austin, (ggg) Zg2-8477. Hearing and speech-impaired individuals with text telephones may contact the Commission at (512) beo-|reo. complaints riay be iiled online s1 www.puc.state.tx.us/ocp/complaints/complain.cfm. Thank you for your prompt attention, lf you have recently Ppid your bill, please disregard this notice. PUC
License'10117 I
rl,
li
$10888
$108.88
07/20 2012
07/23/2012
AD.1206
HA5E
PMorgan
Chaso Bank,NA
Account Numbor
000000994261782
00104860 1 AV 0 35
!
::11[::
1:! 1
[
:
T504694 139
HousTo
Web site: Service Center: Deaf and Hard of Hearingi Para Espanol: lnternational Calls:
1 800
1679
;;il"il6il;n ;;:;rfii"p;lit
Banking seruices and Fees" docum6nt as Elfective July 22,2012, lhose changes will be incorporated inio the'Additional lollows:
In the
"i
.lnsullicient'FtJnds, Returned ltems, and Slop Paymenls" the lee dsscliptions will be changed to: ln the section ca ed
"--'*-"*;Jii;.t
u"s eaaiiiniaily,iiii
it
iii
an lnsufticient Funds Fes il your ending accounl balance is overdrawn by $5 or u"""unt batance ii overdrawn we witl not charge an tnsutticient Funds
I.
W. *u iot ii.rgi .n overdrafi Protection Transfer Fee if your ending account.balance, betore overdratl Protection any overdraft ppte"iii irur"t"r" uru made, is overdrawn by $5 or less or the less' or aro all that $5 t;nstor resutted'lrom transactions
please note that tlrere will be no change to lh amount ol these fees. .All othr t6rms o[ your account agreemenl remain the tf," telephone number listed on this statement or visit your nearest chase fi v", nir" -ny queslions, pGu"""
"i*". branch.
"uii
,tit
charged when you perform balance. Good news. Starting July 22, 20i2, we will reduce the number ol non-Chase ATM lees the same terminal within inouiries or account translers at a nonlif.,u"" nff,a. Fortransaclions performed by the same card.at wilh a withdrawal' done in coniunclion fee if incur a not will transfers u"r"*" i"qriries ano account reduction in the lhanlhis Other charged. will be ATM tee only one non-Chase ure.peiormeJ lt ili.,-u];;,;-6.n6 inqriries As a reminder, ATM lee to lhe Non-Chase nr.6.i ot t."t "t.rg"i fo, inqriri." .;J fi"n"tdr", ther6 ars no other changes charg the owner of lhe non-Chase ATMhay impose an additional
;-ii",,,];;i"1;;;;iii,
;;i;;;;"y
your account agreement remain lhe same ll These changes will be reflectFd ir{ your account agreement. Allother lerms of or visit your noarest chase branch statement on this lisled number at rho teteihone qr""tLn., pf"ui" *ir
I'
,i
Total amount
due
date
$
$
81.65
AMBIT ENERGY
Account A2995064
invoice 996 4Hl
8558
To assist other Texans in paying their utiliV bills, enter your donation and check the box.
rrdirrermt,rom
"Total
Amountenclosed $
Karen Navarrete ,
Please make payment
ilount
due"
to:
Ambit Energy
P.O. Box 66O462
Dallas, TX 75266-0462
Houston, z7911
5 L
LI
LI H L
LL5
55
eaSe mtt ths po bnwlhyolrp Keep this pan fOr your records
Ten Makecheckpayadet
AlllbtEne y
Due Date:06/08/12
Rewards program summary
Points earned this rnonth:675
Total points to date:6,544
AM to
6 PM and Sat 10 AM to 5 PM CT
To report a power outage or emergency' please call Centerpoini at (800) 332-7143
Account Summary
Previous balance
For more information about residential electric service, please visit , l, rii www. Powe rto cho ose. co',li{
,,
$
$
6384
(6634)
Payments received -- Thank youl Prior period miscellaneous adlustments Balance forward Current Ambit Energy charges Centerpoint Charges Taxes and oiher fees Current miscellaneous adjustments Cunent charges dueby 06/08/12
$
$
250
0.00
t'
,.1
$ $
$
$
$
013
7130 720
3.02
8165
Account Details
Houston, TX 77015
ES D:l
ofl
3439
: 1
J:
II
ES10
1
St
average price calculation
h baserde has
Current Charges
Ambit Energy Charges
Energy Charge (25 days, 582 kwh @ $0.0904) Energy Charge (4 days, 93 kwh @ $0.0936)
5261
chm9 b
870 999
Page l of3
>m
dtttO l
Account Number
Billing Date
8777701260367062
05/19/12
$68.44
Unpaid Balance
New Charges Total Amount Due
Due Now
Service Details
Contact us: a)WWw.cOmcast.corn (1)713341 1000
$4335-Due 06/08/12
$111.79 Page 2 of4
'
Digltal Starter
05/24-06/23
5799
: : i
.'
el9?I.9_9
Se ice DiscOunt '?ruce,
] R :
-927
Service Discount
Di91al Adapter Service
'1 05/24-06/23
000
0.00
$9.27
05/24-06/23
1.3!e charo9
Tota:XFINITY TV
$39,99
.The State Cost Recovery Charge is imposed by Comcast on its Because we had already billed you when the latest changes were made to your accounl, we have adjusted this bill' Listed in this section are credlts and/or charges for these changes. Effective O5/08/12, Digital Starter at a monthly rate of a $57.99 was removed from your account. Digital Starter at monthly rate of $57.99 with a mpnthly discount of $18'00 was added to Your account. i
Texas subscribers to recover a portion of its expenses associated wtth charges imposed on Comcast by the State of Texas; Comcast is not required by law to collect this cost. $8.28 ota1 0ther Charges a Credits
Franchise Fee
1 86
2.41
Adjustments for services r*moued osto8,tlz rl L| 05/08 - 05123 Digital starter of$5799
16 days @ $1 .8693/day based.bnia monthly rate
-29'91
008
$4.35
'. 1 ,.,
,1
05/08-05/23
2991
vina sierra
Billing Date:
Unit: Account #: Move in Date: Balance Forward:
05/15/2012
unit 2512
RIV VSA2012042512
02 12 2011
Houston,TX 77015
$3802
Tota:Due:
000163009852641 1
(!f pald by 06/01/2012)
$798.78
Amount
Paid:
Check #:
HouStOn, X 77015-3439
2111 it
Villa Sierra
550 Normandy Street Houston, TX 77015-3598
:lil11:
1i r
::l:llil::::1ll::1lli:lill:l:llil1llllili::1111:::ll=:
,u,h,tlr;;l,llllllllhlhllltll,lllllllllllllll1l!,,,t1,111,111
Fo'propoF Credit,please ddach and return the uppor PC 10n ith your paymOntl Thlnk yO RES:DENT ACCOUNT STATEMENT
Property Fees
$723.00
Unit 251 2
Utility Fees
$37.76
New Charges
5760.76
Balance Forward
S38.02
Total Due
Date Due
06 01 2012
S798.78
Villa Sierra
CHARGE DETA:LS
Outstanding Charges:
Rent Past Due Balance
llRocklreek
$3802
$3802
Property Feesr
Rent
$72300 s72300
urssncE
illi;lill[:l fiilirch4::sI
Water Base A ocation(03/2804/23)
Turn off the water while you shave and save up to 30O gallons a month
S10
RUBS:l Unit X 10
Water Exp occupant A ocatbn(03/23 23)
$000 S20
S0 00
_ RUBS:2 0ccupant X 0
Sewer Base A!location(03/28-04/23)
RUBS:l Unit X 20
Sewer Exp occupant A ocaloo(03/28-04/23)
RUBS:2 0ccupant X 0
Trash Coection Charge(03/28 04/23) Flat Charge
S500 $276
S3776
S798,78
Flat Charge
Ut
Residenl ulility charges are generaled by RockCreek, 4(X)0 lnternalional Pkwy Ste 1000 Canollton, TX 75m7. These charges are allocaled from masler property bills received bylhe propertyfrom lhe respective utllity provider. This bill is notfrom Cily of Houslon. Charges are allocated to resldenls based upon lheir lease agreemenls. For detail on rale calculalions, refer to your residenl portal or conlact lhe propertys managemenl staff. Property Fees reflect data in lhe resident ledger as of lhe date bills were printed and mailed. You are responsible for paying the correcl amount in a limely manner. Please contact your leasing ofl'ice to report any errors or omissions.
'
RP 100
2142
bl
l : l
: l
GUARANTOR NUMBER
iSIA 0 IA
:113
Page Number:1/2
151
For questions related to University of Texas, please call 71 3-500-3500. For questions related to Baylor College of Medicine,
:l:llllll:::::lll::llllllll:l:llllllil:l:lll:::::llll:llll
MESSAGES
Dear KAREN NAVARRE
,
please call
13-798-1 900.
F2
DESCR:PT10N
1 il::::
Total Charges Billed:
T:::
$142.00
ne dsi us at
$000
:::1:11::
$14200
LABORAttORY
Office hours: M-F B:00 a.m. - 4:30 P.m.
lf you have any questions after office ,I hours, you can e-mail us lnsurance Payhehts and Adjustments:
` Payment ttotal: Adiustment Total:
at
CustomerService@hchd.tmc.edu.
1
li
$142.00
-$104.00
',$ j
27/2012 CASH
Adiustment
03 04/2012
$33.00 $71.00
Pleage
CARD NUMBER
SiGNATURE
AMOUNT PAID EXP DATE
lntlENow 0
GUARANTOR NUMBER
STATEMENT DATE
05 17/2012
$38.00
100406287
ll L Ltt 517 7L L
Tota! amount
due
$
$ 6687
AMBITENERGY
Account A2995064
invoice 960B8F8
bSS
:;
$ i::
Amount enclosed
$
Ambit Energy
P.O. Box 66O462
rf
*Total
diffqat
lrom
amount d@"
Dallas, TX 75266-0462
L LI
L B F
L ll
LL 7
Please rnail this portiorl with your payment Make check payable to: Ambit Elrergy. Keep this part for your records.
Y AnnBtTENERG
Account Summary.
;
For more information about residentaal electric service, please visit r www.powertochoose.coq
I
i
Previous balance Payments received -- Thank Youl Prior period miscellaneous adjustments Balance forward Current Ambit Energy charges Centerpoint Charges Taxes and other fees Current miscellaneous adjustments Current charges due by O5/O9/12
$ $ $ $ $
$
6675
16925)
l,i'
5356
$
$ $
6384
Account Details
Houston, TX 77015 3439
ES D:l
ofl
ESID
Term End Date:05/13/12
AMJJASONDJFMA
The average price you paid for electric service this month is $0.123 per kWh. See page 2Ior more information about t average price calculation
Current Charges
Ambit Energy Gharges
Energy Charge (30 days, 482 kwh @
Customer
Charoe
$0.0904)
$ $
+s.sz 9.99
53.56
Pag l of3
Statement Date:
PUC License: 10117
04 I 23 I
12
Due Date:05/09/12
Customer Name: Karen Navarrete Account Number: A2905064 lnvoice Number: 96088FB
$
$
$
210
305
081
102
Credit
$ -------T
$
(0.14)
634
001
60.50
009
0.10
Miscellaneous Adiustments
Current Miscellaneous Adiustments
Late Pavment fot-af Curre-nt t,tiscellaneous
Penaltv
Adjustments
$ $
g.sa
9.34
250
2.50
1.
Page 3 of 3
l{ext Aopointnentl
tridav,
9:ti
AI
PARTl'll
DATE:
TI
av 4.2012
E:12126P
800-S[2-36?8 To reoort a Lost or Stolen card. For ouestions about benefits. call vour clinic: 713'[5]-8125 back to the clinic' the card does not work,in the store, take
calll
It
it
1
CHEESE
[G6S
l,00[6
A OR AA LARG[
ED S ALL
1`00002E
2,00 CT
R
JUIC[610Z& oR 16 02 FRZ
C[R[AL
DRY OR CAll B[A
S
36000 0UllCE
P[ANUT BUTT[R
I`00 1TE
Recipient Si nature
t
*1 * 8 3 8 ** B 881 8
FOR STAFF LISE O LY WICCAT PRI F000 FKG FOR ULA ACTUAL ISS ANCE: F LA'OTY:F
LA OTYoF LA OTY
FDT2:P: 05 CLIENT
== ===========
0
01
2012
=====
====
=====
ARIAH
[:
485
01715018'91
I
ll1 1
CITY OF HOUSTON
Municipal Courts
Annise D. Parker
Mayor
Barbara E.Hartle
Director and Presiding
11
1:]1 1
1:
8594
Houston,Texas 77002
PlYG6400301317-120166266
1:llllilllllllilli::ll!:
T 7138370311
TDD 713 247 8591 www houstOntx 9ov
:::::1:l:illllll:1:llll::::lll:1:l
KAREN NAVARRETE
uear KAREN NAVARRETE follows: This notice serves to remind you that you are scheduled for an ARRAIGNMENT as Location: Ticket Number 130734371 130734371
1(LUBBOCK)
1400 LUBBOCK HOUSTON,TX 77002
Offense Date
03 26 03 26
DATE: 05/02/2012
TIME: 7:00 PM
Offense Case Number 2012 TR 0204033
Amount Due
207.00
2012 2012
2. 3. 4.
1.
Appear in person or request by mail the Driving Safety Course (DSC) Appear in person or request by mail for Deferred Disposition
Pay your by mail) nequest Trial by Judle or a Trial by Jury (from arraignment setting only - no trial resets
,l( t
fine '
http:
.hOuStOntx.qov COurts
2.Do:have to come to courtto hand:e my ticket?NO You mustrequestone ofthe oplons above by ma
date.
'
i [ :[
i
.
t Jtti
1
i 1
ckd dS Ssed?YES Reasesee he MANDATOR DSCRE ONARY
:[ atthttll
t: Tttbgdmy
[e8 tF:
l
l
ltn
1:19 ::
R L li: 11 :::
::
7.Can:request Deferred DislositiOn in the mailto 9et my tiCket dismisSed?YES See app calonfor Deferred DispOsnion prOvidedon the back
:1 TttT:: :] 1:
Settln
h" m a myd
x court b m
m orbebe p
"
10.Can i plead not guilty through the ma ?YES Please see th9 form On the reverse PleaSe note that your case may not bOied on yourlrstiury
P6RTAN
P.0.Box 203735 Houston,TX 77216 3735
L_______ _
04/2472012
IE
100406287
Physician services rnay be b led separately For questions reiated to University of TeXasI
please ca
713-500-3500
MESSAGES
DeaT KAREN NAVARRETE,
DESCR:PT10N
Thank you for choosing Harris County Hospital District for your healthcare
needs.
1: i
Total Charges Billed:
$142.00
LABORATORY
$14200
$0.00 $0.00
$000
$0,00
$142.00
-$104.00
Sincerely,
Harris County Hospital
.i'(. ',
',r,
,i
District
'
02/27/2012 CASH
03 04/2012
$33.00
-$71.00
Adiustment
Please check box if above address is incorrect and indicate change(s) on reverse side. You may pay your bill. By Phone at (713) 566-660d
tr
A fl
CARD NUMBER
SIGNATURE
PAID
EXP DATE
r
IAMOuNTlntlEINOWI
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
04/24/2012
ct
LI L LItt L 7L L 7
FS:0360667252
1 ii
I l lll lllE
lJ,
X77015-34 g HouSTON
5.DiGI = AUTO
77015
GREG ABBoTT
Attorney Ceneral
Date: April22,2012
Si necesita asistencia para leer esta carta' por favor llame al nirmero: (713)150-1442
lARCH,2012.
1 1(I11.
This is a report oftlle sllpport ve collected alld processed for your child(ren)during tllc montll of
DO
VE
. .
total was sent to your famil-v the State for fees owed or TANF payluents how rnuch of the total was kept by the State. Note: This repays you received irl the Past.
(rT
elfare benehts)
TOTALS
(See back for additional hfOmlation)
,
S125.001 S18.0
s NO :A
`pe
Ser ces
The letters
letter "[" stauds for IRS intercept received' Federal the pay..re,.t Type colurur describe which payrnents were received. The Division holds such paymetlts for 120 days after support child law pemrits states to hoto certain IRS intercepts for up to iao auyr. The
i.
payrne,ts received fro,r the obligor. rnay have accrued ou tlte case/cause.
September 2010
..F,,
tltat is for payruents applied to attorney and/or genetic testing fees. Arrears iuclude any iuterest
Fori:16L022
0360667252
HA5E
JPMOFgan Chase Bank,NA
P O Boa1 659754
AcCOunt Number
000000994261782
CUSTOMER SERV:CE:NFORMAT:ON
001 2569
AV 0 35 0110O
T357003 P7677
Web
::11:lllll::11::1`:!`111:1:`ll:::llllllll:=:11::1:=:ill!=::::lil
Chase.com
1-80G935-9935 Deaf and Hard ol Hearing: 'l-800-242-7383 1-877-312-4273 Para Espanol: lnternational Calls: 1-713-262-1679
11
lmporlant lnlormation About Your Account Statement We understand lhe value of being ablo to easily read your stalements and the benefit ol balancing your accounl. To make your slatement easier to lollow, elfeclive March 19, iotz, we moved the Balancing Your Checkbook pag to the last page ol tho slaiement. This Pago may be used lo balance your account lor a given slatement period. ll you have any questions, please call us al the number on this stalemont or
visit your branch.
Starling March 19, 2012, we will lower lhe following leesl on our checking and savings accounts:
. . .
Overdrall Proleclion Transler Fee to $10 Slop Paymenl Fee to $3O pel request nrade with a banker. stop Payment Foe via chasolcom or chase by Phoneo aulomaled Phone system to $25 per request.
u:J1op purr"n, will be in el,ect stop payments made on or aftor March 19, 20'12, on ctrecfs wift now ue etiective tor-opely6gr rither lhan l80 days Depending on how your stop paymenl was originated or Chase by Phoneo), we will send a conlirmalion ol your Stop payment. (request made wilh a banker, via
Fhase.com
that the debit is On ACH transactions, your stop payment v,rill last tor a minimum of 18 months or until we have determined payment is a you tell us il the must payment request, stop n" f"ng.a"""u"rg, *ni"h.r.i ii longer' When making a amount o, the the exact number, give accounl tha bank us payment and must or ariACH transaction i*rrri"ng OrOit "urA designated payee name. payment, and tha
lor Chase These changes will be updated in the Deposit Accounl Agreemenl and Addilional Banking Services and Fees you ll any the same. have remain ycur agreement account personal chJcking and savings acccunls. All olher terms cf questions, please call us at 1-800-935-9935 or visit your nearest Chase branch
1
@
Beqlnnlng BalanGo
Deposits and Additions
Endlng Balance
RETURNSERViCEttL86: +LD
D ar
: h : : 1 !:
D)
Omytt d 1 I
l*ii
anv Westem Union tocatioh ecross fhe country id pAf Fairure to uririze one of th6 pavineni oprions atrovi
',yFlJ..g[,*T[:iJ]s1",,{"?,ff
coririiaiibaue
f,!B:,"rS:, Sincorely,
lrlportantl Maihd
KAREN NAVARRETE
Comcast cabie
pO Box 34227
:l:1
Seattle WA 981241227
=l:ll:::1,l:11=11:1:i:11:111::l::1=l11111::1:l! 1::=l,1:l
87777
=,
111::=li1111=::::!=!II
!jil:illil:lll[lililillI
KAREN NAVARRETE
made paym l
lC ON0
2 Yqur, lu"
1
"y 1
"
ll},i.?f ir,*ft
,lftn#,,ilA,fni*,,.?.
'l nfi
I J
}dir
Comcau
Oni.
res_un in
service intemrption or
communications
payment may take up to 7 days ro _....r and post to ,_ __ ani$ rv your account. rvur quLuu
:t
s72$1I{2PRESGr27
@omcost
1 L L7 L 1
COLLECT10N AGENCY
0017270101
Elmsford,NY 10523
htt J h J
l
Apri1 03,2012
client Lipozene, We have been authorized to contact you regarding your past due account with our is received and you ordered that for Lipozene you owe still LLC. The amount $59.92. payment in the amount our client has referred your account to us because your credit card is no longer valid. Your Creditors your payable to Retrieval-Masters made order g5g.g2 or money check is appreciated. of
Bureau should be sent in the enclosed envelope
if you do not respond, you The reverse side of this letter contains important information about your rights; however, will be subject to additional collection efforts.
11
Detach and return this portion with payment using enclosed envelope
O pay On
Amount Due:
You Owe:
Charge Date:
$59.92
ne:
.pay.retrieValml,ters.cOm
ll`^
Card#:
iAsTFI`AR`
`9o,1111 1
Amount
Lipozen9,LLC
January 27,2012
Account Number:
Pin Number: Name: Street Address: City, State ZiP:
44216521 35233470231
Karen Na arrete
DVA LIP 073
!'t
RMCB
LItt LIP 5
L L 5
+++++ L
Villa Sierra
l'
Billing Date:
Unit:
03/29/2012
Unit 2512
RIV
Account #:
Move in Date:
VSA2012042512
02/12/2011
Balance Forward:
S000 $760.76
Total Due:
oool 63009499848 (lf paid by 04/01/2012)
Karen.Navarrete i
550 Normandy St Apt 2512
'l
'i
Make Payments
Villa Sierra
Houston, TX 77015-3439,',
Houston, X77015-3598
1:::::lli:::::11:::::::::llll:l::::llll::::i::::11:ll:II]
tllt'll'ltll'llllllLlgrrrllrt!3tri;1,t1,;,11t;1,;1l,ll',ltlttl't
Fo propo
credll:please detach and return the upper porti9n With your payment Thank you
New Charges
$760.76
Balance Forward
$0.00
Total Due
Date Due
04 01 2012
$37.76
S760,76
Villa Sierra
CHARGE DEttAILS i
Property Fees: Rent Scheduled Property Fees Due
utility Charges:
VVater Base A ocation(02/05 03
llRock reek
: 11
p O,
Q uessaoE BoARD Water Conservation Tip: . Turn off the water while brushing your teeth
day
Flat Charge
Trash Admin Fee(02/05-03
Flat Charge Ut y Charges Due
02)
S276
$3776
S760.76
TOTAL DUEl
'Residenl utility charges are generated by Rockcreek, 4000 lnternalional Pkwy Sle
1 000 Carrollton, TX 75007. These charges are allocaled from master property bills received by the property from the respectivq utilily provider. This bill is not from City ofHouslon. Charges are allocaled to residpnts based upon lheir lease agreements. For detail on rate calculations, refer lo your resident portal or contact the property's managemenl slaff. Property Fees reflect data in the residenl ledger as of lhe date bills were printed and mailed. You are responsible for paying lhe correcl amount in a timely manner. Please conlacl your leasing oflice to report any errors or
omissions.
RPV-1OO
PO.Box 203735
_1_ li_jL
__:
Houston,TX 77216-3735
EI III
PAYTHlS AMo
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500. For questions related to Baylor College of Medicine, please call 71 3-798-1 900.
Page Numberi l 2
l L
=:llllilllilil11:::::llllllllilllllill::::illilillllillilllilll
F2
MESSAGES
Dear KAREN NAVARREttE,
Thank you for choosing Harns COunty
care Hosplal DistnCt fOr yOur hea
DESCR:PT:ON
,9,,
$142.00
LABORATORY
$14200
$0.00 $0.00 $0.00 $0.00
ITe
hCnd.tm
9 ?OV
I
9Y,?mOrse ,,`
$142.00 $33.00
-$71.00
$104.00
27/2012 CASH
Adiustment
03 04/2012
CW2
XP
MOUNT
PA:D
DATE
GUARANTOR NUMBER
STATEMENT DATE
$38.00
100406287
03/30/2012
LI L 7 L 7L L
AnnBtTENERGY
April 10,2012
Karen
Account Number:
invoice Number:
Bi::ing Date:
A2995064
925E7D4
03/23/42
Navarrete
Past Due:
$66.75 $66'75
o4f20112
04123112
2512 '
TX77015
Navarrete,
I 't i I l;
i
Dear Karen
of your invoice in the amount of $66.75 is past due. To avoid disconnection of service onO4l23l12, payment for current charges with this notice does not payment Disconnect'associated Avoid to Required the'Amt of $66.75 must be received by o4t2ol12.
ii*"ntnrnoit
Energy from disconnecting service if prior invoices have past due charges'
fee of $15.00, a $50.00 reinstatement fee plus applicable taxes' lf lf a disconnect order is sent, you are subject to a disconnect we reserve the right to cancel your currenl plan and reinstate your service you would like Ambit energy io reinslate your ""ri"", Plan. under the Ambit Standard Energy
our customer care Team is available You can pay your bill by phone al (877) 282-.6?8 or online at www'ambitenergy.com' accept payments made at ACE Cash p'm. We 6t. to 5:00 Monday - Friday, A:OO alm.-to O:00 p.;. anO SaturOay 10:00 a.m. A list of locations is available on locations' Pay convenience z1874) Union western or select Express, MoneyGram (receive code your remittance slip with payment' processing and inc,lude our website. please attow business days for transaction
call.Ambit Energy customer care al (877\ 282-6248 to discuss lf you are ill or need assistance paying your bill by the due date, state oifederal agencies' lf a deposit is on record, it will pJyr"nt assistance.from possibre or an alternate payment arrangement you. lf you failto make satisfactory payment or enter into a to remai'"iin[ Jeposit returned tn" rinaiuiri *itn be applied towards to collect payment, including the use of "ny payment arrangement *ii[n*oit Energy, we will"use various methodsio attempt remedies allowed by law. Any inquiries other court and/or consumer reporting agencies, debt coll-ection agencies, small claims lf you are not satisfied with our (871 282-6248. at Care Customer rn"rgy nmoit related to this notification inouto be referred to commission of rexas, P'o' Utility Public or writing the response to your lnquiry oi'compLint, yo, mav_rii" a "ornpi"int oy calling speech impaired individuals and (88S) Hearing 78i-8477ar Texas in Box 13326, Austin, Tx,'78711"t ISTZiSSO-7'l'2o or toll{ree online at filed can-be Complaints (512) 93G7136. Commission the contact *itn ifil"i"pnones [Tt-y) may your prompt attention. lf you have recently paid your bill, please www.puc.state.tx.uvocplJo-rdl"int"7;ilplain.cfm. Thani you for disregard this
1
I
'lil
,l
t
_ _ _ _
lercJy
AD 0908
Annetr EN ERGY
Account A2995064 lnvoice 925E7D4
TotalAmount Due
Amount Enclosed
$ $
550 NomandPApt2512
Houston,llX 77015
5 L14
5E7D LI
LL75
: :l
FS:358597578
1 `1 :: : :`11`
P O BOX 12048
AUSTIN,TX 78711 2048
770
GREG ABBoTT
Attorncy Gcncral
7824 1 AT 0 374
HOUSTON TX 77015-3 39
:
11::]l::::lll:::lllil1311:::lll]::l:ll: lll.1111::::]:11::`l:l:
'
HOUSTON EAST
CHlLD SUPPORT UNIT 0606E
12605 EAST FWY STE 300
HOUSTON,TX 77015
(713)450-4442
1fyou have questions orllced infottation on your case,please contact the ne
lllttlil
ately ten virlilidaySI Om ttC datc OfthiS ICttCr fbr yOur caSC tO reach lhC nc
Sincercly,
Septetrrber 2005
Fonn 5L013E
t
I
.r'l';.rlcrt-$.
cr
NIarch 20,2012
Dear Patient,
Our office has attempted to contact you to schedule an appointment with LBJ AUDIOLOGY clinic. Please call the Harris County Hospital District Referral Center to schedule an appointment.
' `0
` `
` `
/7
/21 o
'
g
`
, r ,7 (f , e`
( `
(/t 4 '
ARABITENERGY
Account A2995064
invoice 925E7D4
Totalamount
due
Amount due if paid after due date To assist other Texans in paying their utility bills, enter your donation and check the box.
7009
droront
from
Amount enclosed $
Karen Navarrete
Please make payment to:
Ambit Energy
Sarnount due
Houston, 77011
1 11
: )
L ll
5E7D ll
LL75
Please mail this portion with your payment. Make check payable to: Ambit Energy'
PUC Cense:10117
Due Date:04/09/12
Rewards program summary
Points earned this rnonth:550
Total points to date:5,387
AnnBTTENERG
F
Customer Care:18771282-6248
urs of Opera10ni Mon ,8 AM to
7143
6 PM and Sat10 AM to 5 PM CT
To report a power outage or emergency,
please c I Centerpoint rnt 1800)332
Account Summary
Previous balance Payments received -- Thank youl Balance forward
9914
(9914)
ac 1
:
See page 2 fbr additionalimportant
$ $ $
$
0 693
011
Current Ambit Energy charges Centerpoint Charges Taxes and other fees Current charges due by 04/09/.12
5971
$
$
6675
66.75 0.
messages
Account Details
16K
ESifb: 1 or
1000
1 1
Current Plan: Lone Star Select - 6 Month Term Plan
Term End Date:05/13/12
500 0
MAMJJASONDJFM
The average price you paid for electric service this month is $0.1 19 per kWh. See page 2for more information about ,i average price
Current Charges
Ambit Energy Charges
Energy Charge (29 days, 550 kwh @ $0.0904)
calculation
Customer Charge
4972 999
59.71
Page l of3
EHASE
ATM&DEB: CARD VVITHDRAWALS
DATE DESCRIPT10N (continued)
h March 15,2012
Account Number
000000994261782
AMOUNT
03/07 acklN The Box 3695 Houston ttX Card 9893 1 3378 Woodiorest Blvd C10Verleaf ttX Card 9893
Vickis Bar And Grl
AMOUNT
otal
Fees&Other Withdrawa:s
Pege 4 ol 4
100406287
IPAY THiS
$38.00
Physician services may be billed separately. For questions related to University of Texas, please call 71 3-500-3500: For questions related to Baylor College of Medicine, please call 71 3-798-1900.
HOUSTON:TX 77015-3439
NttT
MESSAGES
Dear KAREN NAVARRETE,
Thank you for choosing Har is County
H9,plal DISt Ctfor y9
r
DESCR:PT:ON
ealhcare
J:: : :: : I
11 :102r27r21121=::: atill 011=1110 TPATI
$142.00 $142.00
$0.00 $0.00 $0.00 $0.00
LABORAttORY
lnsurance Payments and Adiustments:
Payment ttota!:
Adiustment Total:
Transferred to Pa ent Responsibil:ty:
$142.00
$33.00
-$71.00
$104.00
27/2012 CASH
2012 Adlustment
Oo 04
ARDNUMBER
ICVY2
XP
PA!D
DATE
GUARANTOR NUMBER
TATEMENT DATE
03 05/2012
$38.00
100406287
LI L 7 7L 5 L q L
Total amount
due
$ $
101.69
AnnBtTENERGY
Account
2995064 invoice 856E2G9
Amount due if Paid after due date To assist other Texans in paying their utility bills, enter your donation and check the box.
106.77
$_ _
$ r d fferent from
Tottt
amount due
Amount enclosed
Karen Navarrete . 550 Norrnandy St Apt 2512
Houston,TX 71791
Please make payment to:
Ambit Energy
P O Box 6a1462
Dallas,TX 75266-0462
L LI
5LE 6
l LL
L L77
.\-
etease nlail this portion with your payment Make check payable to: Ambit Energy.
AMBITENERGY
PUC Ucense: 101 7
.l
Due Date:02/10/12
Rewards program summary
Points earned this month:1,032
Totai points to date:3,994
Account Summary
Previous balance Payments received -- Thank You! Prior period miscellaneous adjustments Balance torward Current Ambit EnergY charges Centerpoint Charges Taxes and other fees Current charges duebY O2/1O/12
For more information about residentiat electric i service, Please visit i I, www. powe rto c h o o se. c cj rfi 'f i lmportant Messages
',
See page 2 for additional important messages.
$
$
017
10169
101.69 0.
Account Details
ES D:l
ofl
1 1
: i
Term End Date:05/13/12
The average price you paid for electric service this month is $0.092 per kWh. See 'rl page 2 for more information ! ,rJrrg" price
JFMAMJJASONDJ
Current Gharges
Ambit Energy Gharges
Energy Charge (33 days, 1,032
about calculation
kwh
$0.0904)
9329
93.29
Page l of3
ANNBIT
March 13,2012
Karen Navarrete
EN
1
ERGY
Account Number: lnvoice Number: Billing Date:
Past Due: Amt. Required to Avoid Disconnect:
Due Date:
A2995064 890B6H5
02 23712
$99.14 $99.14
03r23 12
Disconnect Date:
Re: Disconnect Notice
0 6r12
your invoice
in the amount of $99.14 is past.due. To avoid disconnection of service on03/26112, payment for current charges of $99.14 must be received by O3123112. Paympnt of the 'Amt Required to Avoid Disconnect' associated with this notice does not prevent Ambit Energy from disconnecting service if prior invoices have past due charges.
lf a disconnect order is sent, you are subject tp a disconnect fee of $15.00, a $50.00 reinstatement fee plus applicable taxes. lf you would like Ambit Energy io reinstate your service, we reserye the right to cancel your current plan and reinstate your service under the Ambit Standard Energy Plan.
you can pay your bill by phone al (B7Z) 282-6248 or online at www.ambitenergy.com. Our Customer Care Team is available '10:00 a.m. to 5:00 p.m. CT. We accept payments made at ACE Cash Monday - ftfuay, 8:00 a.m. to 6:00 p.m. and Saturday
jnclude your remittance slip with payment. oui website. Please allow 2 business days for transaction processing and
cde
4874) or select Western Union Convenience Pay locations. A list of locations is available on
be applied towirds the finaabill with any remaining deposit returned t9 you. lf you fail lo.make satislactory payment or enter into a p"yrbnt arrangement with Ambit Energy, we will use various methods to attempt to collect payment, including the use of . repo-,ting aqencies, debt collection agencies, small claims court and/or other remedies allowed qy llw.Any inquiries "on"r;n"r related to thii notific.rion should be referred to Ambit Er r. ! / Cuslomer Care at (877) 2$2-6248. lf you are not sal;slred with our response to your inqrriry or complaint, you may file a compkrint by calling or writing the Public Utility Commission of Texas, P.O. Aoi tggzO, Austin, tx,-78711ai (stzigsO-2120 ortoll-free in Texas at (888) 782-8477. Hearing and speech impaired individuals with text telephones (TTY) may contact the Commission (512) 93&7136. Complaints can be filed online at www.puc.state.tx.uJocp/complaintsTcomplain.cfm. Thank you for your prompt attention. lf you have recently paid your bill, please disregard this notice.
Sincere:y,
(877\ 282-6248 to discuss lf you are ill or need assistance paying your bill by the due date, call Ambit Energy Customer Care at an alternate payment arrangemeni or possible payment assistance from state or federal agencies. lf a deposit is on record, it will
Ambit Energy
AD 0908
ent
AMB:T ENERGY
Account A2995064
lnvoice
TotalAmount
890B6H5
Due
[$[$
,r4l
Amount Enciosed
X77015
5 L `
LI
BLH5
lL
LI
l lll 11111
FS:0354606097
I II
5-DIGI AU 0
77045
GREG ABBoTT
Attorncy Ccilcral
HO S ON, X77015-4323
1111::l::ll:l :::::!:!:l l" l:Hill: lll ll::ll:l!:lll:l:
13213 KNOLLCREST ST
WE
Ou
VING
YOU
: y tllcl li anloullt collected aurillg a fl11l servicepcriod(SCe no below) how much of the total rvas seut to your farnily owed or TANF pal'rnents (welfare benehts) how much of the totai r+as kept by the State. Note: This repays the State for fees
CT10N
. .
PA
OR NA lE
CSEI
CAUSE
PROCESS
DATE
PAY lENT
DATE OF
A 10UN
RECEIVED
JONES JONES
0()12301907
201067934 201067934
12/13/11 12/23/11
12/13/11 f2/28/11
W W
S5769 $5769
$5769 $5769
$(
00
0012301907
3000
TOTALS
(See back for additional inforlnation)
Sl15.38
pcriod S` NOTE:A/t`
1lg aln child suppolt enforccmellt ser ces by ule Child suppolt D ision
Septernber ?010
!1 lM
0351606097 Fonn 6L022
ir
@omcost.
Contact us:
cOmca .
m e 433 000
Karen Navarrete
550 NORMANDY ST APT 2512 HOUSTON TX 77015-3439
Previous Balance Payment - 01l1gll2 - Thank You Unpaid Balance - Oue Now New Charges - Due by O2lo1l12
See below for more information
14290
-5000
9290 8279
S175.69
6799
-242
ri , li
.: :
LCu
RI
VERS ONE
t ttSt D I
AL C RO P
Date:9/13 20 2
Resident Ledger
te
Code
Name
arc00196 1 1
Karen N:
Address
C:ty St.Zip
#2512
Houston
Rent
X77015 PhOne(0)
723
(832)748-3874 Charge
95.18 35.00
MOVe Out
PhOne(H)
Date
8
Description
Initial Load(rent)
Payment
Balance
95.18
Chg/Rec
32224281 32224467 21670444 32229380 21724431 21724432 32355837 32355894 32703477 32793125 32793362 32793692 32793693 32812569 21996859 33276986 33366908 33367105 33367304 33369544 22208749 22230696 33495398 33842959 33919054 33919285 33919514 33919743 33973179 33973192 22545760 34001787
31/2011
8/31/2011 8/31/2011
9
1/2011
Rent(09/2011)
713.00
9/19/2011 9/19/2011 9/26/2011 9/26/2011 10/1/2011 10/1/2011 10/1/2011 10/1/2011 10/1/2011 10/14/2011 10/17/2011 11/1/2011 11/1/2011 11/1/2011 11/1/2011 11/1/2011 11/4/2011
11 5/2011
chk#291000970 chk#291000971
Reimbursed Water Late Fees Rent (10/2011) Reimb Wateri(10/2011) Reimb Sewerl(10/2011)
ReiFnb ttrO,h(10/2011) Reimb Traqh (10/2011) Late Fe
1,
90)
27.42
172.48 713.00
6.44 12.89 5.33
2.76
(172.48) 0.00
120.00
chk#372366 92
Rent(11/2011) 713.00
13.52 6.76
5.33
sewer(11/2oll) Water(11/2011)
Trash(11/2011)
Bil!ing Fees(11/2011)
2.76
chk#14372306900
chk# 372306937
Rent is late
11/25/2011
12
26.21
0.00
1/2011
Rent(12/2qll)
713.00
13.25 6.62 5.33 2.76
12/1
2011
Sewer(12/2011)
Water(12 2011)
Trash(12 2011)
B ling
Fees(.12/2011)
100.00
(50.00)
chk#406529820
Nov late fee bal. 23.79
(15.25)
https://voyager.myriverstone.com/voyager60/reports/Resident
L...
9l13l20l2
Unit:
Unit 2512
RIV VSA2012042512
Account#:
Move in Date:
02/12/2011
Ba:ance Forward:
$000
760.76
Total Due:
(lf pald by 05/01/2012)
000163009741767
Amount
Karen Navarrete
Paid:
Check #:
1 i
l
::ll:!::lllll:::l:l]]1llll
::
Foi' propcr cledit, please detach and reiurn the uppei' poition wi'th youi'payment. Thank you
New Charges
5760.76
Balance Forward
$0.00
Total Due
Date Due
05 01/2012
$37.76
S760.76
Villa Sierra
Unit 2512
CHARGE DETAILS'
Property Fees: Rent Scheduled Property Fees Due
1 li
$72300 $72300 $1000 5000
HoustonittX 77015
Q uessece BoARD
Water Conservation
RUBSil Unl X 20
RUBSi2 0ccupant X 0
Trash Conec10n charge(03/02-03/28)
Flat Charge
charges Due
Resident utility charges are generaled by RockCreek, 4fiX) lnlernational Pkwy Sle 1000 Carrolllon, TX 75007. These charges are allocaled from master property bills received by the proprly from lhe respeclive ulility provider. This bill is not from City of Houslon. Charges are allocated to residenls based upon lheir lease agreemenls. For detail on rate calculalions, refer to your resident porlal oI conlacl lhe Property's managemenl staff. Properly Fees reflecl dala iil lhe residenl ledger as of the dale bills were printed and mailed. You are responsjble for paying the correct amounl in a. timely manner. Please conlact your leaqing office to report any errors or
'
omissions.
RPVLloo
2142
0000:0001:RPV-100
(QESP)10:T004:001349,001:1000:10733465:MSVO
.1
Ful Log, :'h, , .9'1 :L'N 7, , C,1,P: 1:,` FttP',', " piiCor . JI r erl. 1 . : ___, ______ 1988 Sex = F No HIPPA _ ^`^ L ^"^ MRN: 037849472 DOB: 9 =Al^u NavaFrete,Karen r : 1 : : l::: ::Lu 0457940064232 Unl BT 6B M MEDiCiNE 110090411
lP.:
, , 1
ll
21
. . IFt lvl,w
li `1
1111
Seleded
jtter Repo
,SIt11 3
111
1111, ,1
Te lea
eiesh l Se ed 1 De6eled 11
Re ew
'PM
ptt EleS
Encountts tLabstil
s L E
Procedu
0 Ordersi
l: 11111: 19 ILette,1lmQlllLi
All C le
4,
::il;
No lilters applied
02/27/2012
0121
FAMPST
IFAMPST
Heanng lrrpairment(
11 03/182011 0929/2010
09 7/2010
ler(Ou13 1
Appo ntment
lApppl,1 ,olll
FAMPST
No Show
Appointment
Apppintmenl11
:pFNIWF FAMPST
IST LICI
NO,Slow
No Show
Okoh. ennlfer o
Shih,Ching Lan
9 191 lfer19 .
108 lo
Nt ShOw
No Show
05 4/2010
Appointment
DENTST
IFAMPSTI
0241F 1
01/057_9010
. P,inipent
Appointr ent
DENTST
DEbIIST
NI1519w lll
No Show
Shih`Ching Lan
I IIII lSlil:Chi Olt
1141
10/19/2009
1
Applintmenl l
Letter(0
t)
FAMPST
II
ol152009
e,: IApp
H slory
10/06/2009 1,4 II
10 2/_2009
109
FAMPST
,WSI
I 111 111111111
Okoh` ennlfer O
,0 ce Vis
:
I
IFAMPST
NIVST
01,111an 101
.:
SI`
stll(S,Xu1 1
Appoiniment
Appl:nt ,
No Show
i
1720091
I WST FAMPST
FAMPST
BYELIC
::
ISh,wl
09/E14/2009
E19 4/20ED
09 42009 04 7r2CX19
PCP/Clinic Ch 111loFy
pllllll
lfer 0
omce
s"
0koh, ennifer O
Heakh Maintenance
Appointment
lortl 1 191
B06
l2-11-08
through
APPA
01-09-09 6
MyAccers Checking
KAREN NAVABRETE.MATA
ms i
586007949824
&
B::::::
12 17
10,00 10.00
$ZO.OO
Bolonce
Date Beginning
Balance($)
46.63
Date
T,
12
Balance($)
26.63
17
Bank of America,N.A. P.O Box 26118
Page 1 of
07-14-09
Statement Period
Tamp
FL 33622 6118
O APPA 6 OI1 Numbsr of checks enclosed: 0 Account Number: 6860 0794 S824
B06
thrortgh
08-11-09'
ll
1111,: ll11,1,l
::111]lllillill :!:ll
1:
:1:]1!
!:::]1:!l
l 1
120,9 001 SC
999
Our free Online Banking service allows you to check balances, track ac_coun-t activity, pay bills and more. With Onliie Banking you can also view up to 18 months of this statoment online and even turn off delivery of your paPer ststement Enroll at www.bankofamerica'com'
::'lrrl
He o Ki
B i :f ttl
;& : `J :
i
9824
Harr
Cou Taas(R"02")
THE PEACE, PRECINCT 3 PLACE PARROTT 14350 WALLISVILLE ROAD SUITE 02 HOUSTON TX 77049 4135 ( 7 3 )450-2409
W
Ma
50.00 50.00
:cASH
Payment Amount
Change nemitted:
TR3 X0383771
VS.
Card/Money
Fel Number: Auth Code: Slgnature:
Exp
Date:
NAVARRETTE KAREN
HOUSTON
TX 770 5
Payor's Copy
Received By:
u8 B
Page 1 of
06-11-09
Statement Poriod
806 0 APPA 6
throrigh 07"13'09'
014
111:]:1111
:ll
l]
]l:111
!llll ::]l
1:1::!11.1:l!
Banking Bervice allows you to check balances, track ac-count activity,. pay bills and more' our free - - -Witf, -- Online 18 months of this statement Ci;ii;" Banking you can also view up to paPer statement your of off delivery turn online and e-ven
Enroll at www'bankofamerica'com'
806 0 APPA 6
through
06'10-09
01,
:11:l
!1111, i:l
111
ll::111::
!:::11111:! l::
I
KAREN NAVARREttE MAttA 450 NORMANDY Stt AP 314 HOUS ON TX 77015 3469
11099 001 SC
999
Our free Online Banking service allows you to check balances, t_rack ac-count activity,. pay bills and more' Witt Or,tif;" Banking you can also view' up to 18 months of this statement online and eien trrrn off delivery-of your paper statement. Enroll at www.bankofamerica'com'
He o Ki
586007949824
: 1
06 10
8.95
. d :
04 11 09
B06 0 APPA 6
thl'ollgh 06
08 09
011
l!: :!::
,11
:lllll:]ll:
1]::
Banking service allorvs you to check balances, t-rack ac-count activity,. pay bills and more' Our free ----Witf, -- Online B";kilt yorr"."r also wiew up. to 18 months of this statement d;iffi" -"rriir," and eien turn off delivery.of your paPer statement' Enroll at www'bankofamerica'com'
Recently we informed yoU that we were raising our Overdraft ltem Fee and N-S^R-Ret"^l:-d,11:lli"-"^t^: impacting the economy, our business and $3g. After careful consideration of the many faitors currently ltem Fee at our customers, we rrur" r*C" a decision to leave our overdraft ltem Fee and NSF: Returned $35 per item. Vislt bankofamerica.com/pricingchanges
! 'I
B06 () APPA 6
through
06'08-09
OIi
:::
i1
Balance($) Date
04 20 04 21 04 22
04 17 04 20 04 21
Date
Balanee($)
Date
05 08
Balance($)
48.34
F
04 17
ng
2.48
145.52 143.52
11
1'I
B06
()II
0
9 1
450 NORMANDY Stt AP 314 HouSTON TX 77015 3469
Banking Eervice allows you to-check balances,-track a.ccount.activity,.pay bills and more. our free -- online --'-Wit[-O"tifi" Banking you can also view up_to l8 months of this staternent online and eien turn off delivery of your Paper statement'
Enroll at www.bankofamerica.com'
oiod ::
03 12 09 through 04 10 09
306 0 APPA 6
011
4000
2000 1156
6.48
s"r;;
Ct::
CheckC[1 0313xC
:llf
Purchase
31[11:
::J:l::::12460120
2900010600129
':J;l::
2000
1613
11.90
20
399
1078 1000 1000 1000 1000
8.65 7.62
03 23 03 23 03 23 03 23 03 23 03 23 03 23
0323
CheckCard 0319 01d Texatt CaFe
03 23 03 23 03 30
497
175 106 1942
Pasadena lX 24071059079987105350056 CheckCard 0320 RedbOx Dvd o O 3104 866 733 2693 24427339079720027743422 Che :: 1:400
iCard7f3& 89
: II enod
03 12
B06 0 APPA 6
09 throllgh 04
10
09
015
0,83
1.47
Date
Balance($)
4.47
r
1,II I
I
11
'
Date
03 20 03 23 03 30 03 31 04 01 04 02
Balance($)
83.47 6.47
Date
04 03 04 06 04 07 04 08 04 10
Balance($)
101.47
12.47
ng
03 13 03 16 03 17 03 19
68.47
13.47
153.47
3.47
2.48
161.47
193.47 141.47
Page l o'6
Statoment Period
02 07 09
B06 0 APPA 6
throllgh 03 11109
01
ll
1lll 1llll
1ll:
]:[!lill]:!::11:l
11ll::l:].:
:::
1 1
, :E
lxt]
EI
1,TA314
Ow i OJttti
please read Bank of America'Privacy Policy for Consumers 2009 carefully for important information. lf you have other accounts with Bank of America you may receive more than one 2009 privacy policy
notlfication.For rnore informOtlon,vlsit www.bankofamerica.CO m/privacy.
H
d e :
02 07 09
B06 0 APPA 6
through 03
11
09
016
Account Number:586007949824
MyAccess
Purchase Clothes Max 02/13 1L055 East Freewa Hous(on TX BkofAmerica ATM 02/15 #000008428 Withdrwl Normandv Plaza Houston TX CheckCard- O2l4 Cindv Nails 2
hec
king Subrtroclions
te
02 17 02 17 02 17 02 17 02 17 02 17 02 17 02 17 02 17 02 18 02 18 02 19 02 19 02 19 02 19 02 19 02 19 02 23 02 23 02 23 02 23 02 23 02 23 02 23 02 24 02 25 02 27
Fallae Paredes 02/13 #000036857 Purchase Fallae Paredes #0 Houeton TX Valero #2517 02116 #000623300 Purchase 623 Pasadena Blvd Pasadena TX Wal Wal-Mart S 021L4 #000839296 Purchase 1137 Wal-Sams Houston TX Valero #2517 02/16 #000322500 Purchase 623 Pasadena Blvd Pasadena TX CheckCard 0214 Jack IN The 8o00036954 Subwav #6434 021L7 #000872000 Purchase 161 Pasadena Town Pasadena TX CheckCard 0216 SubwaY #6434
Houston
TX
24792629046207899600071
Houston
TN
24164079045783000191811
Pasadena T7-24427339048710009966040 Subwav #6434 02/18 #000437700 Purchase 161 Pasadena Town Paeadena TX
Wal Wal-Mart
1137
Wal-Same Houeton' TX Wal Wal-Mart S OZIIS #0004762!1 Purchase 1137 Wal-Same Houston TX
TX Same 7 Davs Fo 02ltg #O0070p071 Purchase TX Sams 7 Davs Food Houstciir :
tZ-620
Kroeer
Woodforest Houston
22L3 " 02/18 #000092100'Purchase Houeton TX Normandv " Stoo-N-Jov #2 O%ltg #000117800 Purchase Houston TX tbgs Uvalde Dr Wal Wal-Mart S 02122 #000120874 Purchase 113? Wal-Same Houston TX CheckCard 0219 Sunriee Super 00448761 Houston TX 2416407905L623167656076 CheckCard 0221 Jack IN The 8o00036954 Houston TN 24164079053783000132863
V"l""o
703
33.36
10.00 6.47
5
41
Paeadena TX 24427339052710011370333 Normandv Food 02121 #000780800 Purchase 792 Noimandv St Houstonl TX Ct C""a OZig .la"X IN The 8o00036954 ""t TX 24L64079051783000L20L26 Houaton
CheckCard 0220 Chick-Fil-A #{,0247
4.99
4.64
1.46 5.40 2.17
Check0ard 0222 Jack IN The 8o00006338 Houston TX 241640790547830001829L7 Check0ard 0224 Redbox Dvd 0{2-9202 866-?33-269 3 TX 24427 3390 F57 20022012L7 7 BkofAmerica ATM 02127 #000001664 Withdrwl Pasadena TX StOre#2517
Pasadena
T)K24427339052710011879002
20.00
through 0$'ll-09 ()IT O APPA 6 Numbsr of checks enclosed: 0 Account Number: 6860 0794 9824
02-07-09
B06
03 05 03 09 03 10 03 11
Date
Balance($)
78.42
39 42
Date
02 18 02 19 02 23 02 24 02 25 02 27 03 02
Balance($)
6.42
Date
03 03 03 03 03 06 03 09 03 10 03 11
Balance($)
255,42 218.42 444.42 73.42 46.42 22.42
4.47
ng
02 10 02 11 02 12 02 13 02 17
04 05
126.42
15,42
266.42
i ll
0l-10-09
B06
through
APPA
02'06'09
6
1
v 9
1::::
01 26 01 29 01 29 02 02 02 05 02 06
11.00
20.00
20 00
S 0U31 #000793794 Purchase 1137 Wal-Sams Houston TX Exxonmobil 02101 #000959660 Purchaee Houston T,( Sunmart 150 Purchase 01131 Familv Dollar - sr+"No"*andv St #000098500 Houston TX CheckCard 0151 Mcdonald'S F2132 Houston TX 244273390327100296L3273 CheckCard 0201 Redbox Dvd 012-9763 866-733-2 69 3 lL 24427 3390327 2002L987 27 8 CheckCard 0131 Jack IN Tt1e1 8o00006239 Houeton TX 24l64079032783000t499il p4?'9393
CheckCard 0201 Redbox Dv.d
866-733-269 3
02 02 02 02 02 02 02 02 02 02 02 02 02 02 02 03 02 03 02 02
14.05 10,00 5.41 2.35 2.17 2.15 1.08 5,40 4.01 13.71 4.97 4.97 2.68
TX
244273390$2?200207 28558
Sellers Bros
Subwav
Pasadena TX 2M92809033118000193367 #25t7 OZl03 #000266600 Furchase oCa Pasaaena Blvd Pasadena TX
04 04
Town Pasadena TX
02 05 02 05 02 06 02 06 02 o6 02 06
Paeadena
623 Pasadena Blvd Pasadena TX Sou Ross Store 02/05 #000003787 Purchase 5955 E Sam Housto Houston TX Wal-Mart #3500 02/05 #000052000 Purchase 5655 Eaet Sam Hou Houston TX BkofAmerica ATM 02/05 #000003067 Withdrwl
#25L7
22.00
19.54 10.00 5.41
T)( East Houston Subwav #6434 02106 ffi00743700 Purchase 161 Pasadena Town Pasadena TX
BIC Houston
B06
OIO 0
$6,06
Date
Balance($)
Date
Balance($)
Date
Balance($)
55,37 78.42
F
01 29
ng
26.63 15.63
24.37
L=_1
L_J
[_
t H uSToN
Tx 7,015-0000
2
[VV 2
Cry C For EMPTOYEE'S lo FECGDS (S l{& EnTiqa6Bdcq8.) fttur4ffibft bn.utu,.l'.@ad tu.Ebdrb11@dFrE
806
11-07-08
through
APPA
12'10'08
6
Go Paperless.
Your Account
Account Number
i
Deposit
'I
m8
586007949824
& g 1 il
10 00
Date Beginning
Balance($)
56.63
Date
12 04
Balance($)
46.63
806
t0-11-08
through
APPA
11-06-08
6
iittifl
Account Number
586007949824
gr ::lg : 1
:
Beginning
Page 2 of
Statement Period
09-11-08
B06 () APPA
through
10-10-08
6
l
$
g 1 ::
56.63
Date Posted
09
Amount(
10.00
23
_rl
Monthly Maintenance Fee l)
10
10
5.95
,9ily B :
Date Balance($)
60.68
__
Date
10 10
Date
09 23
Balance($)
50.68
Balance($)
56.63
Beginning
1 riod :
08 12
B06 0 APPA 6
08 throllgh 09
10
08
011
ll
1]!
11, l
::111:
110'9 001 SC
M
999 1
5 0
Banking service allows you to check balances, t^rack ac.coun-t activity,. pay bills and more. our free -- online ----Wit[ ing yoo"""r, also view- up.to 18 months of this statement d;ifitB""t -"r.iir," and eien turn off delivery of yorrr paper statement'
Enroll at www.bankofamerica'com'
you see on Go paperless with your apco&nt statements and get all the same information online that you go green help paperless you even and o-rganized keep statements fiapbr'ror free in ontine Banking. 'by'reducing paper. plus, you, can see.your cleared checks for eligible checking accounts. lt's easy 6i.orio,.,',6n into onrlnL'aairking todiy at www.bankofamerica.com and look for the green leaf and.click Go Paperless.
Page
I oI 4
through
08-11'08
O1I
Stat6ment Poriod
08-0?.08
T6mpa, EL 33622'5118
B06OAPPA 6
Banking service ullows you to chech balancee, track account activity, pay bille and more' Our free Online ""'wi1, of this statement ciiiiif;" s""ki"; r"r"."" also view up to lE months paPer atatoment' ygur off delivory^of turn .*ven .t d online Enroll at www'bankofamerlca.com'
you free admission to over 70 As a valued Bank of America customer, Museums on us@ provides or history'.. whatever you're science art, naflonwide the first weekend of every month. Explore or ATM card and your photo lD at into! ft'" on us -.iust by showing your Bank of America check, credit or text reminders vlsit email ro learir more and to slgn up for monthly plrtiJip"ting bankofamerica.com/artsonuq.
I50
,u""rr"
,ri.rri.
In
: fettoHod
08 07 08
B06 0 APPA 6
throllgh 08
11 08
0187
03/10#000491d3b l lnq
dy
$2.00
::Il::I:i:::::i:[illi:::::::::!:::
________
Date
5'
ng
Balance($)
0,00 18.00
Date
08 08 08 11
Balance($)
70.00 30.00
FI
Date
6 10
2008
Barcode, 447502
PERSONAL:NFORMAT:ON
/ /
ACCO
NAVARRETE
as rvame
Mlddle
mployet
mOer
sL
6 10
So:d On 2008
Date of B:rth
9 21
Barcode:D
147502
1988
Recumng
Service List
Fee Taxes
lnitiation
EFT Dues
Dues
TeFnS
so oo
$49.00 $4.04
Dues lnveslment
S995
$2500 32804
$5,JO4
l tti
: Contracl Star Date:6
:: ::l :]
1 072008
Apep d
lo etectronilly debit (-EFT") my monthly Dues or any past due paymenls from lhe accounl I used to pay lhe deposil or the above account. The debits may begin on the above date a;d continue unlit my membershii i;te;i;;i"J, or I notify Fitness connection. in writing, by certifled mail, to stop. ""n""r"0,
Signature
lf lhe club closes at any lime within twenty-tour monlhs of ths date of lhis agrement and fails lo proviJe altemate facililies within ten mites of the club then the member will be reimbursed the unused portion of all amounts paid;l the tir" rn" ,o*"i"-nii. Jt-neol witn rrre enrolment fee, the prepaid
a month{o-month basis aier expiralion of the twenty-four months. The terms described above have been explained to me The foregoing was exptained to the member
rit"";"c;nr""uonwflrconlinue(hemembershipon
wrbally. wrbafly.
Member lnilials
E;pt"y""
i"iii"[5
after the day you sign this contract,-to Bn;l this ;gr""r"ni-y* .r"r give written notice by certified mail.and also.retum all contract coples, temporary erds, and /or regular membership cards lo: torir uemmerty aua, box roz, Bv signing belowyou agree to allthe lems on the tront and back piges of tnis agreeme"a;;;;;*i;;;;iiaiyou recereo a copy of rhis agreement
NoTIcE To PURCHASER - 3 DAY CANCELLATIoN RIGHT: Do nol sign lhls cootract until you read it or if it contains btank spaces. tf you decide you do not wish to remain I member oI Filness.cof,neclion, you may canel lhis ontracl by mailing to iitness ionnealon uy midnighl of rhe third business day (excluding sundays and Holidays)
xourio",'il;;;;
cosrGiER
Assumption of Rtsk and Arbitration ctauses in this Agreement. and I promise to pay - anyfnancial obligalion lhal my mlnor child does nol pay lor any reason. t' I agree to lhe Abilrallon clause in this Agrement, aia t promise to pay any tinanciat obtigation that the member does not pay for .- ::"J3f any
I
gree to the
whelher Parent or cosioner, I understand my obligation can only end if lhe member propedy terminales the membership according to this Agreement. ll I signed the EFT Authorization, t agree to A'irectt! pay aaording to tne tems tn this Agree;enl.
Cosigner Signature: Prinl Name: Streeti cny,state,Zipl Member Signature Dale Signed:Home Phone Work Phone:
[VV 2
[In t
GISELLE
(Child's Legal Nrme)
JONES
n 1 1
by
:N
(Deliveing
l'>hYsrqian)
03:52 PM
(TimC Of Birtil)
as a
SINGLE
(Pl ralit
)
FEMALE
(CCnder)
This was a
KAREN
NAVARRETE
(MOthCrs Namc PHorto First Mal agc)
who was
at
born 09 I
21 / 1988 in
MEXICO
Bi h) (MOthCrs Placc
794 NORMANDY#lH5
(Slreet ,\ddrcss or Rural Localion)
which HARRIS
(Courty ol Residence)
iS
IMS,01)
HousTON
(City OI Rcsidence)
County,
TEXAS
(State of Resideilce)
77015
i3213
KNOLLCREST
HoUSTON
GISELL
EXAS
JONES
77015
lS DAVIN
ONEAL
(Fatheis Name)
JONES
I=OUISIANA
(FaLher's Place
1985 1n
of Birrh)
have rcvie
atitisc
.
nlaking a false statelllent in this fbrnl can be 2-10 years in prison and a tlne of up to S10,000.
cC.195,1989)
tt
Parent
sisnature(s)
VSl+II EV 5/05
1)atc
CITY OF HOUSTON
TEXAS
USA
STATE OF TEXAS
Chlds Name FIrst
Middle
CERTiFiCATE OF BIRTH
Last
BIRTH NUMBER
sumk
12/12/2007
nd",)
ALE
Or tth
6a PI l singl
IT
ml SINGLE
HARRIS
78 PlaOe of b
HOIISrrON
_
7,Nam
Of
,sPlu
03:52 PM
-9C
SINGLE
,NPI I`Not:nSltu G" s"
A ressl
HoSPital
3
Attendant
KIMBERLY HAWKINS
jOANp INI
.D.
lo Momers Name rnOrto r
KARttI
NAVARRE E
tp
09/21 1988
C ,T m or LOCallon
MEXICO
TEXAS
130 41p cooo
HARRIS
1 nsloo w ul
HOIISTON l
9Att IISarne
794 NORMANDY
:o
'
/
77015
11213KNOLLC= iioIIsTOtlTEXA'7701:
Middlo
surlx
10 0ate o1 6Mh(mmdabl
17 3mplaces L,TmloFy"F
"n Coun
10/10/1985
LOuISIANA
18a.tsd
Fils Number
'l
8c Rgistrar Slgnalue
0267560
12/19/20o7
DATE
lssuED
Jul 30,
2oo9'' '.
,'.,:
.'j,i'..
'
Z
BtJREAU OF VITAL STAISTICS
Lisa Akhcimame,Rcgistra
This is to certify that lhis is a true and conect reproduction of the original record as recorded in this otfice. lssued under authority of Section 191 .051 , Health and Saiety Code of Texas. This copy not valid wilhcnrt engraved border displaying seal and signature of lhe Begistar.
Hl RI
7
ADMISSION
EXAMINIiGil
BY BLOoD TYPE&Rh
35
I i"?A1L?Ya.1"l'i X 8t :=
PN
lruUrnrtorv, rotr,ie;
8 HEART NCLUDING
2.sK:N
H
3 HEAQ NECK
creHeronrmiroral
PU
:0.GEN:TAL:A
CIRCuMIsION
(TESTES,
4. EYES
(ABNORNALITIES,
: ll
rrNclUirvc
.LuNGS
enEAsr
I I I
'
DIET2
Application for Certifi cateiAPPlicacion para Certificado Bureou ol Vilal Statistics OSPHP
telcfono)
Y32)zov''
m,.,ns.;artfullybctorctompletingnppircatlon -';:;,;:;;;;;; ;;i,,n,rcnci"n'n ol" unres'te thnar esrulorno . ,i.-" ,,n "f tf* 'rpplicarron is lcfi blank rl wrll bc relumcd' 'i",)i\)i,,i,,,:,, r,jit,,Ptic"' i;' '\z rei\lhttno sLrc re+tu\ddo qpplicalron' . I'r'i,,i," nsurt lligrhrlrly sce back of rtlis i,i,'r,r''n uhtJ' La to vltsina ,<'puesto (onduclco lhal irny limc a far'h tor a cnrlr'alc rs . tr,, ' s,,," '"quit.s o:srancr IIt criuar to rhe ctnrncdr teewrrr .l::;:,; '';;l:;';; illil".J i"""rt r*t arc nor t(tundable or rrcnsferablc L"r /et
';i,;;,:;;::;',;," ,t,* e busca un 'e,vicodo t no se .'. ''-nlo d'l hu:qucla tlu,.t a ctcos@ urso ,;,,,,, :;,;;,;,,;,l '; ,
',1,',,,)i
de
17otb
Porconcro)
i,,
,r
..t" *
ts !*re'dLt" nt t',r,,Jcrthte'
'
W (
`
Signed
Size
Complcto)
S2300 S2300
Fact aclo dc Nacimiento)
cver bCen a
.rr-g.,
"d.p,i;;-. "t*.dmcnl
c"t
filcd to this
lf
-o
Certirlcad S21 1Xl
Sigl
Solterola)
Extra $41111
M3medr
Casadola)
Widowedl
Viudola)
volced Divorciado13)
: 1 ll j L caDl 0"'
MESSAGE
FROM
SOCIAL
SECURITY
you should receive your baby's social security card in about 5 weeks' takes about 5 weeks before the information about In your state,,it yo,r-r baby,s birtfr is provided to the Social security Administration' Social Security is given information After the birth is relistered, whichweusetoissueyourbabyaSocialsecuritycard.Thecard will be mailed to yo., it about 1 week after we are notified by the State of your babY's birth.
benefits If you are filing for Welfare or other public assistance comPleted information the following need for your babY, You will before you leawe the facilitY.
This certifies that a social security number was requested for
MAR:AH GISELLE ONES
Name of Chi d
ity
officia
NOTE: Notify
Ve your babyrs
DEAR PARENTS.
THE MoTH ER,S woRKSH EET FoR cH ILD,S BIRTH cERTI FICATE To youR NURSEAS SOONAS POSSIBLE (DO NOTTAKE lT HOMEWITHYOU.) IFYOU GO CAN BRINGYOUTHE PAPERWORK REGARDINGTHE BIRTH HOME BEFOREANYONE rrt CERTTFTCATE e4nSE Cnll MEDICAL RECORDSAT 7t3-393-2170 oR 713-393-2164. 't l,
PLEASE TU RN
Certified Birth Cert)ficote is a permanent legal document filed in the State ofTexas that establishes your child's identity and is used to apply for medical or government services, passports, school admission, etc.
lf you answered "Yeql' 1o ,n" question,"APPly for baby's social security number"' the birth information will be'ib4Xrvarded to the Social Security Administration as soon as theTexasVital Statistic office .".4i"". the data from the hospital.The Social Security Administration then requires 2-3 weeks tq process the information. A social security card will be mailed to the mother's mailing address as provided in this worksheet.The entire process usually takes 4'6
weeks to complete. "\A/hen will t recqive my baby's Medicaid number!" lf you provided an answer for the questions "Mothert Medicaid Name?" and "Mother's Medicaid
Number?", the birth linformation will be forwarded to the Medicaid office as soon as theTexas Vital Statistic office receives the data from the hosPital. Medicaid then requires 2-3 weeks to process the information.An lnfant Medicaid card will be mailed to the mothert mailing address as provided in this wi2rksheet.The entire process usually takes 4'6 weeks to complete.
n
l"
FnFMF1946 S1l DRP01 12/11 200707:22
NAVARRETE,KAREN
D
HaWkins Kimbe
12111/07
Form VV
2 VV
,ops,Other compensalon
827.76
827.76
Employer's name,
security lax
INC
10
Depsndenl care benelits
5
5 Medicare wages and lps
6 Medicare tax withheld
.33
2.03
for box 12
0.00
23- 9775 4
Employee's s@ial
ssurity number
TX
16
827.76
0.00
1 8 LocJ wages,IPs,e
827.76
19
o,
20
Localily name
Q0
reasury
Visl lhe lRS website al lt/ rs g /eFllp
This inlomation is being lumished to the lnlemal Rvenue Seryice. ll you are requ[ed lo llle a lax relurn, a negligere penany or olher srctis may be imposed 6 you al lhas income is taxable and you lail lo rcpod il.
Statement e005
INC.
l WageS,lps,other compensalon
827.76
827.76 827.76
9.83
5
I I
.33
10
13 ] %
o-oo 0. 00 t
2.03
Nonqualified plans
0.00
1 4 01her
b Employo
iden lca
on number(EIN)
23- 9775 4
5
1 6 State wages, ps,elc
936-79-4692
State income lax
TX copy
827.76
17
_.-_
1 8 Local wages,ups,etc
'19
""
0_,,-0-_0
827,76
.-"
..- .
0:00
20
Localily name
reasury
visnthe lRS website at www llS g
r le
98296130112597
2821722545
Philadelphia,PA 19255
(2151516-4846
0ryou may wrile us ati
Than6 you for your Form w-7, Application Number, we assigneo you n'lN
toi lns
936-79-q69?
is not a Social Security Number (SSN). t is for income ta:< purposes only.. please use your I-l-lNwhen an SSN is iequested onany U.S. Federal lncome Tax Return' Use and atry your l-l-lN on all correspot'ldenpe with the iRS, including tax payments, refund claims, 'r"i, g233 you give to your employer o.r payer. Form 8233 is used to claim an exempion from delays u.s.withholding tax. Using arryvarialion'in'your name or l-l-lN may cause processing and incorrect information on your acccunt '
your
l-l-lir,l
-:. ;.
you become a U.S. resident or a U.S. citizen, you will probably be eligible to get an SSN. [f so, you must tlren appty for an SSt.l from the Social Security Administralion and start an SSN, please using that number for tax purpoies instead of your fflN. When you receive ."nj a cop)r of your sociai security card, along with a copy of this notioe to the address listed above, so that we can update our recordsff
: Ou:ldVe
ahove
ELEMENttARY, INttERMEDIAttE,MIDDLE&
SCHOOL RECORDS
HIGH SCHOOL
FROM
05/09/1995
O
10/08/2007
Sales Receipt
Date
10/8/2007 Sale No. 1208
Houston, TX77015
So:d o
I
r
770t5
neiutts in
*ittrin Z l/2
weeks
Total
$o.oo
713-453 0310
Marque
Tranecripts Katen Navartete Name: 13213 Knolcrcst Address:- Phone: _ _ 832-20 4817 ^ Semestet
Couree English Math
Social Security
936-19-4692
==
Houston,
/ /111.
IX
I
Crcdis
1 1 1 1
1
Semestet
Course
English
'
Gtade
16 96 94 92 96 90
MatI
Math U.S. History
Science
Ma&
!flotld History
Science
Bible
lrork
Study
II Gtade 78 89 94 88 92 100
Ctedits
1
1 1
1 1 7
Total Credits:
Total Ctedits:
Semestet
Grade
94 92 84 88
100
III
Ctedlts
1 1
1 1
Semestet
Coutse
Eoglish Geometry Geogtaphy
Science
fV
Credits
1
1 1
Home Ec
1
1 1 7
Total Ctedits:
24
oi
Ring Size
(use enclosed ring size4
Birthstone Month
Graduation Year
Engraving
(12 characlers ma)dmum)
Ye:low
Ring size
(lJse enclosed ring sizer)
Birthstone Month
Gradualion Year
Engraving
(12 characters maximum)
NOT be shipped to a PO Box address Your ng wl be Shipped via a cOmmercial car er wnh receipt signature required Your nng wi
Name
Address
City State/ZIP
Telephone No
14K
Gold O Money Order EnClosed
Sterling
Silver
1250
$ $
Shipping&Hand ng
1250
sHIP TO ADDRESS
METHOD OF PAYMENT
O Visa C)MasterCard
O Discover
lll
Expira on
Dalr
F :
Full Legal Name (LFM) NaVar
:i::[:[ :[::
STATE OF TEXAS ACADEMIC ACHIEVEMENT RECORD (ACCREDITED) District. Name calena park ISD Name of sch@l
11
e
^-1
Program Type
Lang Arts
Mat
ALC A
ALC l B
s ia
Studies
n Lanquages
Technica App6
7eer/TecnE0
0
BClS ATP:
lCIAL
herElectives
Envelope)
LOCal Credit
aEEIIEGU?r Emf ;4-6E3trwti.o.nrr'r'cnPr'P,L'Lo'rElPrce p-lP, O.E.,AP, R.su|mr, T-Crdt V.r1f, V.Courra trk n vtch dlficd crdt, H.hF.t, bfil J-E!or. 9th, (.E.-Irc, o! r.t.111t. brodcut. ''x' d.not.E t.'.6 z-Dt.r.nc. kamtry coura. hcl@1ng bur roi rr"rt.a to !v. .lcctrmlc,
Enroll ln
I.l/D 1l-13-C5
Home School
FOR LOCAL USE STANDARDIZED TEST RESULTS
REQUESTING AGENCY
DATE SENT
SPECIAL COMMENTS
North Shore Senior High DANGER OF LOST CREDIT DATES: 08/14/06 T0 12/ 4/06 RUN DATE: 09/21/06 STUDENT: Karen Mo Navarrete KEY: NAVARKAR000 AGE: 18 GRADE: 10 ADVISOR: Shtt f et PHONE: (713) 455-0565
ATTENDANCE INFORMAT10N FOR: Karen M. Navarrete PERIOD: 2 TEACHER NF 4E PERIOD ABS CNT CLASS cLASS UNKNOWN 2 3 = DATE 09/07/2006 09/15/2006 09/18/2006 DOW -0THU FRI MON -1
-2A A
A
-3
-4
-5
-6
-7
-8
-9
-10-
TYPE/REASON
ONEXCOSED UNEXCOSED UNEXCUSED
Naviarrete
Grade:10
=90 100.
3=80189 :
E=75 79
Lttf i:1
U=UNSATISFA(
ORY
ROVEMENT
'
111
CZ
PRl
vreber
TT
li
0000
0.000
1
0
0
0
Spanigh I A
rn ntit,
Environ Syst A
Branca p
71r
Chemistry I A
lA
H:
E
S
95
80
0.000
01
0000
:
Tlinv
79
MoRF FO'OUIZZES&TES
ORIG:NAL DOCuMENT HAS A COLORED BAC GROuND AND IS PR:NTED WiTH OP CAL DETERRENT TECHNOLOGV
Galena Park Independent School District North Shore Senior High School 353 N. Castlegory Houston, fX 77049
U.S.POSTAGE
Pald l oz.
Permit No.565
RETURN SER iCE REQUESTED
'"
iii""i"5""
t cns Di
0 TO B
STUDENT:
'
KEY: NAVARKARO00 AGE: L'l ADVISOR: Shif let GRADE: l-0 PHONE: (713) 455-0565
Karen Navarrete
1
DATE
3 English III
sLASS
-5-
-6-
-7-
-3-
-lo
TYPE/REASON
TEACHER ATTEN TEACHER ATTEN
ONEXCUSED
03/23/2005
o9/o9/2005
TUE
FRI
10/12/2005
WED
PA 17102
1
0420279
EPI:
1 1 u S t tlit d,1l cl l tt II
l ::1
1 1,1 I R
I
911
l111:
:'11)
19 1
Ll}I11(OS
0 (1
1.
II I11
:IIll
AL
:{:A/FIII 31CArt
11 I
11)'I ttt
I F tt V
PIIE
VAC
C)0
51CK
C)0
=RIT
HlSC.
r ."8 .3
TAL
.00 .00
00
()(D
Y T p
.04
A CR:::1'13(VTD):
:
8. 3
n TE:
0.00 0 00 ,6.81
W= K OF
06/0 /01
EH l it4 1 NC:
V^CATI1
'`. .
:Navarrete,Karen 0 ReJew 1
:L::;::
39
::lt
8 21
2004
1
8T 63 MEDiC:NE 110090411
LastllfFeShi 310313,,M
: ,I I
ittitl111 [ 11
lear
A
`tttt
094/2009 09 42009
PCP/Clinic Ch
P',Fl,Flr
Hi119,yl
FAL4PST
09 4/2009
,041
omce isI
Appoint lnt
l
FAMPST
BYELIG
Health Maintenanee
rJ,,,, 111
72119
21/20CHI
103/2
3/20/2004 104 7/m4
03 1/2004
1 F312001
Admi,9il,(,1:
Histolcal visl iO101C1111111
6B
91 ok,Mattlew M
carnck,Matthew M
Ta,1lLbJ`Me11,Oi S
03
31/2004
0P isI
0P
sI
6520
de VLarrondo.Lisa E IIIFOnl,I.Ll,
IHi 9 cll11111
03/E18/2004
:,
ECPDLB
3/2001
J I:
03 8/2004
11111417/2003
08 4/2000
H stolcal visn
Histo cal il
BELC
Taub
Lbj.Medica S
10703/17/1997
H stoHca v sn
Histo"cal lil H sto:ica visI
:!St, 11111,il l
PALSLB
PALSLB
F,IP,lletlCI
Ia I:Lb
Taub Lbj,Medica S
IMOdioai s Taub Lbj`Medical S
1246r199
12/11/1996
PALSLB
IECPD
1 9/1996
01/01/1900
Ped EC FacuL
13134
511 :j10
lth
111
.: FII:ONuisin9
Re
t PUI St LRelea
F
Unit:
es
')
aLo9
1 1 .i. =in
Navarrete,Karen "
Karel F
11.
____,_
037849472
8 20 2004
DOB:
Sex:
Adm D
Dis OL
Account: 0,1579{8061232
Chart Reuiew
Last refresh:3103:38 Pm
lE)U",rrrn l=.*,*rt^,,
=lDEserectAIr
I Elneviewserectea
ffitulasrerRapod
lo A
P :
10 3/2012
10
Appoinlnr enl
DENTST
12112
Appoinlmenl
Appointm ent Nurse Triage Appointment
03/31/2012
00/31r 112
FAMPST FAMPST
iVp:
ADMASK
DENTST
07/26/2012
032 917
0321/2012
Appoinirnenl
Telephone Orders Only Appointment
,
DENTGU
FAMPST
FAMPST
BWST
Ilr11,11Andr'W,pps
Randle,Melissa`LVIJ
O "1l ,91 Mp .
03-112
03/01/2012 014 12 02/29/2012
Appointment
Teleplrone
LABWST FAMPST
LABVVST
BWST
Randle(Melissa`LVN
ion s
02
11
Appointment
Appointrnenl [.listory Ofllce Visil
02/272012
102121 17
02/27/2012 03F241 11 03/18/2011
FAMPST
FAMPST
FttPST
Letter (Out)
Appointment
FAMPST
DENTCTR
OIMD
o929/201o
09707/2010 y nl 31
,{!pointrnenl
Appointm enl
FAMPST
STEttG
FL10 ngil
Okoh, enn fer O
Appoinlment
BERTItA RODRIGUEZ
5tartl
111
,Producuon[nv on
3100 FM
I F
r
daY
Navarrete
Weeks Report Card Grade:
PLEASURE
?E NEVT IN CLASS
,,
fle
:
Advancement of Mexican-Amedcons
Nm
Dcpamm
Cmpm 1
/ /4 2
#ofPage
fot
TLc Advucrmeot of
FrxNumber:
Phone Numbr
7t?- ZzZ - /o t/ t .
I
Mcicrn-Arerlcoor
'
GP
Cit
llow0orn
S :Teb(
Ph el mber
:77023
F Number:71[ 21_6960
713 921_1188
A PR00RAH6
l __AAMA Sanchez maner ngh _AAMA Addantc Adult Progr_ _ Pro ect H lomdcs Acdon o m _M House A
Bamos Uid s _ _ L Dillo Pr c _AANIA Selcna Cent udl) __ A ConcdiO nsllan 1bre _ n6Y S Ces __AttMA Buetl Saltld BOad OfDrectoFS
Notos / Commsnts:
dJdStraton
_AAMA Pr cd a.s
_M
tt H
__0 o
tad
{arur1 /*
's
/-7
Hclping Pcople
C Lnttd
Notle
Ttc irformedou cmaircd ia 6ir lAx rnry tr toa i lcntll mdor privibg.{. Ttl IAX L intmd"d io b. rczkrtd b; oa! $t txliyidu.I n!n.d rbom. tf &. r.rd.! of thi tIr$! i ld Fr6. ir ooi thi inEndcd rfiipi.s .! r rEDrtrc rtiy of 6c inteid.d Eripico! you gt [:ncby ootiSed thl u, .cvicv or crpyinr or' h; trAX or tlc loJor'Ilrtiol| .onr.in d h.r.itr t Prsbi]lrtd. If ror lIavc EGivcd 0ir trAX ia .ror, pb.Jr cohtalt iairEdisr.U ii. ,.: lct br i.l.pho.l. rld d.rtry 6ir IAX THANKYCIU
i.
\lr4A Houre
Au 25,2004
Karen Navarrete eDterr rd AAMA House July 5, 2004. At first Karen was very quiet, and respectfir l. Client was ort top of things doing as the proBrarn was designed to do she adapted to the AAMA House environmcnt quickly, and started socializir.g with other clients. At fugt it started oa wrth mi'or problerns ex: forrl lau11.age, uot doing chores etc- (typicat toenage behaviors). Towards the end rf July that is when Kar.er woukl not listir to stalf, staft'would have to telt rer multiple tirrres to do her chores, hrrn her rnusic dour, watch her obso,i ue language, and to respect staff and other clients. client also had many inappropriatc behaviors with male clients, such as minor argrrments with rnal,, clients, r)i(i,g, and minor physical coutact. Prograrn Manager, and Case. ,4anagor spoke to Karen, and gave her, aud the otlrcr eliuets verbal warnings. On JulV 27 ,2004 clierr : Karer was put on a behavior con$act due to not complyiug wrth the rules, imd was told if she acted or.rt again shc woult'l be discharged from the progl,i m. That same uight the clientsivere taken out rlr an aotivity to watch a Hour ton comets basketball garne. Karen and other fernale clients sat behind the lrale clients. which werJthere ro enjoy the game. Karen, and anoiher fen: irle client were acting an ifthey wereineezirrg ant placing small amounts 01' ,vater on their hands and flickins it to the oaie clients. Stafl intelvened. and r ave a verbal warning to the clients. The Ibllowing day Karen and othr ibmale clients were throwing sonre articles of clothes inthe hallway, and wr: .e ecting as if they were fiehring all while using profanity. chents were t;rld multiple times to calnr down. clicnts kept on until the behavior died out hat niglrt. These are.lust a fbw exanrples, which lead to the discharge o!' Karen Nat'arrete on July 29, 2004. I; closing if you need auy more infonual,on please feel fue to contact me.
DOB:
8/25/2004 Reason For Withdrawal:
Inc.
Withdrawal Date:
Agency/Person Requesting WD:
IIPE
STUDENT ISINCARCERATED.
& Period
lst
2 d
II A
IA
Ed II A
3rd
4th
5th
ISI A
IA
fol 9 Districts'
concerning this student,Please colltact hiS home campus or home school district
OF
Counselor Sign.lur
SrhoolScal
Attendance/
Asst Principal
Counselor
A studeot must return school tie or pay for aoy items tbat have been damaged/lttst before school records catr be released by Highpoint'
Date Tie Turned
Irl:
(If Tie
Principal
A/L 2
DATE -DATE T/L TDY DATE U/L IINX DATE E rER DATE LEAVE 8/03 / / / / / / 03/ 03 / 3L/ 04 --
03l17 H9LTDAY 03/18 olTis-noiioav o:Zrs-noiipei -i------03/26A ----rAAoz'/za, ----"t-A- 03/2s Xtriilo."l---ii-o1'rzi L.u vrl 04/o2s ssss-------ssss n2 /ro oru l6e - - - -aqj\.i\ o:/ll- --ss---- o4l01s wrt.r 04109 HoLTDAY cccc---o4l08c o+toZ'i trrr----- o4'/o7c ----CCcc iti'toip, ----rA-A cccc-------cccc ----6ggg o4'/1.4c cccc---- 04/1sc CCCC---- 04/L6c 612li-ro"rr"? oi}l1i gsgg-------ssss 04/23s o4'/2Lc ----cccc 04/22c 04/a9c ----cccc o+tz6d l------04/30 -------o+'/zA -- ---- - 04/29
r.A/1Aa z \ro oeee v.r,I vrt vJ
DAY 50123455789 DAY S0L23455789 DAY s0r2345578g DAY S0123455789 DAY 50123456789 H6LTDAY 03/1e II9LTDAY
;.il;
nE/^1
cqqq---- oatzi
--------
05/L3 -------'---- --- os'/t2 -------ou'tro -------- os'/1; - -- - ---- 05/20 -------- 05/2t tg oi't os/rg -. ---. -------^E/11 a=eus "i'=r* c=cii'p=ooc E=EXC r=rss M=TST N=NUR o=oFF s=sus r'=rDY
r5/04 --------
05/05
-----. -- 05/06
--------
05/07 05/L4
GE/ 8R KU IC :
ATPCRT
PRESENT
TOTALS
tINDO
XFER
C r
O/C C
J
Presented to
Tbe Association
fo,
Hea1th and Human Services Division 204 C[fton Street, Houston, Texas 77011
7-c-o{
Intervention Specialist
ID
3415
Navarrete, Karen
04/12/04
Grade 09
05/27/04
Course
Academ c Marks 5th 6th SEM SEM 6wk 6wk EXM GRD
70 90 50 89 70 50
96 55 50 61 70 50
65 65 50 64 59 55
'
PAGE l OF l
INC : Incomplete
Houston, TX 11049
ID 3415
Navarrete, Karen
04/12/04
Grade
09
05/27/04
Course
Rhoden,
96 55 50 61 70 50
65 65 50 64 59 55
' PAGE 1 0F l
'
CONDUCT MARKS (CitZ) O = Outstanding s = Sat sfactory N = Needs lmprovement U = Unsat sfactOry
INC = Incomplete
GRADE SU
2322 NAVARRETE
MIDDLE
NAME
PEttANENTI 0000202272
PAGE O OF 02
PRDlg
18
: M
+
:1 II
WLD GEOGRAPH B BIOLOGY I B ALGEBRA IB COMMtNIC APPLIC PERS&FAM DEV B PE FOUNDAT10NS HEALTH ENGLISH I B PERS&FAM DEV A ENGLISH I A TEEN LEADERSHIP ALGEBRA IA
2 3
4 5
6 7
2 3
50 70 50 50 72 50 95 60 65 60 87 50
54 50 50 50 63 50 50 50 72 60 32 55
S S S S
S S S
-+---+---+----+----8
B188
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 00 0.00 0.00 0.00 0.00
7 8 8 8 0
8
4 4 7 4
52 70 83 60
62 70 85
50
63 64 84 54
S S
0.50 0.50 0 0.50 0 0.50 0 0.50 0 0.50 0 0.50 0 0.50 0 0.50 0 0.50 0 0.50 0 0.50
0 0
DATE:
ACAD GPA:
0.225
TOT GPA:
0_225
E=EXIT
F=FORWARD
G=GET
4/23/04 TIME:
NAML
Not following instructions
DATES OF BEHA OR
Profanity
Talking
ilo
permission
Offtask / daydreaming
Sleeping / head down Refirsing to do class work
Out of
seat
Jewelry
Qn
Teacher Signature
"
Principal's Disposition:
PrinclpaVAssist Pttclpal
Date
Reviscd 3/6
00
Off
tark
/ day&caoing
Lyi"e
Stealhg
Icwclry
Cang rclalcd acd ty
Other VI laiolls:
Comments On Back
Tcachcr Sigrrahrrc
0,
Principal's Disposition:
PJhcipaVAssist.Pdncipal
Datc
d3/m
GRADE
IIAST NAME
MIDDLE NAME
su
WttY
-1::
PERMANE oo00202
C T
+
3: 8::
ili3: i
zE :Y ]EI:
1
01 o2 o3 o4 05 o6 07 08 09
0 2
::
8
7
:3
0.00 0_00 0.00 0.00 0.00 0.00 0_00 0.00 0.00 0.00 0.00 0.00
+ +
2 2
2
2 2 2 2 2
WLD GEOGRAPH B BIOLOGY I B ALGEBRA IB IC APPLIC COW PERS&FAM DEV B PE FOU DATIONS HEALTH ENGLISI I B PERS&FAM DEV A ENGLISH I A TEEN LEADERSHIP ALGEBRA IA
2
3
4 5 6 7 8
3
4
50 70 50 50 72 50 95 60 65 60 87 50
54 50 50 50 63 50 50 50 72 60 82 55
8
8
8
0
8
4 4 7 4
52 70 83 60
62 70 85 50
63 64 84 54
0 0 0 0 0 0 0 0 0 0 0
0_50 0.50 0.50 0 50 0.50 0.50 0_50 0.50 0 50 0.50 0.50 0.50
DAILY-ATTN:0.0
E=EXIT
ACAD GPA:
0.225 G=GET
TOT GPA:
F=FORWARD
F HELP
L=LAST
ATE:
ScufflinglHorseplay
VerbaUphysical threats or arguing
Offtask / daydreaming
Sleeping / head down
Lyrng
Stealing Gurrq candy, food or drinks Inappropriate materials Dress code/shirt untucked-sagging
Jewelry
Gang related activity
Other Violations:
Principa1/Assist.PHncipal
Rcviscd 3/6/00
NAVARRETE
LAST NAME
FIRST NAME
KAREN
1 (:
----qCCC or/osc cccc---- o!/oec ----cccc oi7os""oiip"y olioac cccc---- or/o7c AAAA---OL/1-5C ----CCCC ol/L6c CCCC---i1 /1)e ccee---- 01l1aa ---,gggg 0L/r4A ----cccc o!/23c cccc-------cccc or/zLc cccc---- ot/22c ssss---oiiig"rSiio"v or't)oi 01/30A ----AAAA iti'tizc"-____'cicc o1,'tzii cccc---- o-t-'/28s ----ssss oL/2es ----BSBB 02/o4E EEEE---- 02/ose ----EEEE 02/o6c cccc---$'toii Aiuu\---- oz'/ozg' EEEE---o2'/1,1c ----CCCC 02/!2C CCCC---- 02/t3C ----CCCC ol'togi -----cccc o2'/LOE "oi?12*ror.,roii-----cccc 02/7ec cccc---- 02/2oc ----cccc oz'ttii cccc---- 02/t1c CCCC---02/26C ----CCCC 02/27C CCCC---o)/)1a cccc---- 02/24 -------- o2'/25C DDD----- 03/0sr ----rrAoi?olc il_-ssss o3'/o,c cccc---_ o3l03c ----cccc 03/o4D 03i08- o------- o:7osE ----sBss 03,/1oA AAAA---- 03/11 ------A- 03/L2 A------A=IJNXB=BUSC=CFSD=DoCE=EXCI=ISSM=TSTN=NIJRo=oFES=SUST=IDY
/ THRU: / CODE: ALL: CODE: DATE: CHANGE END FORWARD GET LAST NEXT PRESENT TOTALS IINDO XFER BACKUP F =HELP F2=ME W ATPCRT
DATE: 4/23/04 TIME:
:
FRIDAY WEDNESDAY THURSDAY S0123455789 DAY S0123456789 DAY DAY S0123455789 DAy S01234s5789 -- DAy s0123455789
I:::;131E
A`L ::
ATE I
MONDAY
TUESDAY
8:52
3/
SUSPENSION NOTICE
DAY(S).
sCH00L A
5/
F b-24-04
03:071111
lr ufl illlilPvlllt
EClt
h
E)istrict
9
`iS
Home Campus Grade
t. 2
3.
4.
5_
6.
term) Expulslon Letter from District (inctudes: reason' minimum Student lnformation Forms (Entry, Health) Federat Lunch PrOgram ApplicatiOn
PermiSSiOn Forrns(1, ,I:l,Request fOr lnfOrTnation) Ackn ledgement Agreements Techn 10gy,Code of Conduct,Handbook)
OHentation HandbOok H19hl19hts
7.
8.
9.
Appearance I Dress Gode I Contraband - Student lnitials: Uniform Fee I Loan Agreement I Receipt Special Educatton Exit or ExPuleion Requiremenls Election of Service
10_
11.
12.
13.
14_
15,
COntra (Parent,Student)
Opinion Survey(Parent,Student)
Flrst Day of SCh001:
17. NotifY ISD transPortation 18. Current TranscriPt 19. Latest Report Card / Withdrawal Grades 20- Attendance Record
Discipline Record imrnunization RecoFd currentiEP{S) Student Folder Comp:ete:
Hl-qh
point lnterviewer
09 0-9
MTWTFS CRS XXXXX 402502 XXXXX 3 3502 XXXXX 2 502 XXXXX 8 0000 XXXXX 789502 XXXXX 5 3000 XXXXX 5 0000 XXXXX 02502
COIJRSE TITLE WLD GEOGRApH B BIOLOGY I B ALGEBRA IB COMMINIC AppLIC PERS&FAM DEV B PE FOUNDAT ONS HEALTH ENGLISI I B
-x---------x---------x---------x---------x---------x---------x---------x-
0L234567 89 TCH TEACHER NAME 406=GABINO R. 308=ALLEN B 204 BARNES,P. 5 8+BoNILLA R. 702 ACOBS C. 508=MCGRUDER K. 507'HARRISON L. 7'AMAYA A.
CODE: SEC: CRS: TCH: ADD BACK CHG DRP EXIT FWD GET LOCK N RNG PRI r REQSTS SCHED WINDOW X SW UNLK STUCRT F =HELP F2 MEAIU DATE: 4/23/04 TIME:
: 3:25
t G
I 2ust
ciI
Student SS#or PE
iS#
is
Horfie [,anguag,
L h
Sp.Ed.:
Ycs
504:
Yes
Father's Name
Mother's Name
Guardiao's Name
Ticketed: Arrested:
'77 o tS
Zip
1 lib2
Phone #
Ifyes,Cittdon 4
5 7
Ycs Yes
Description of [ncident:
lfyes, Case #.
CFS#Days
JJAEP(Tcl
24-
Waiver:
S Placement
ITCm
No
11)
Ycs
Comments:
Parcnt Notification of Action:
Ycs
No
No
bc nodf l of dlc dcc bn to remoVC a studcntftom school as soon as homc with thc studcnt' or by other rcarooebly possiblc. iic noti." rnay bc uradc by tclcphonc, by notc scnt rpgroptiltc nrcans. Perent(s) will recelvc r copy of this form'
CANARY COrV:Parcnt PINK COPY:Studcnt Discip:inc Filc
3
LA
SUSPENS10N NOTICE
Z
DAY(S).
BEENSUSP7NDD F M CNERFOR
succEssron
sCH00L ACHV
I b oTAmND,
OR rARIICIPATE IN ANY
gJL AME:t
Not following instructions Not accepting criticism
Scuffling/Horseplay
VerbaVphysical threats or arguing Profanity
ddnl$
Inappropriate materials
Dress code./shirt untucked-sagging Jewelry Gang related activity
Other Violations:
>
Teacher Signature
Lnt
'pcipal's Disposition:
raUAssist. Principal
Date
Revised 3 6/00
NAML n4
Not following instructions Not accepting criticism Not accepting "No"
Swearing/disrespectful language voice/tone Inappropriate gestureVfacial expressions
DATES OF BEHA OR
Profanity
Offtask/ daydreaming
Sleeping / head down Refusing to do class work
Out of seat
Lyrng
Stealing
Other.Violat ion",
,/(atz.r- t , ,C U/.1
Principal's Disposition:
PrincipaUAssist. Principal
Date
Rcviscd 3/6/00
_
'l'lo"
OR
Not acccpting
Scufilhg/florseplay
VcrbaUphys ica I threats or arguing
Profaaity
Talking
Off
iask
o permission
/ day&eaming
Out of scat
Marking on/in school propcrty Throwiog objecs
Lvtue
Stcalfug
Iewclry
Catrg rclatcd sctiyity Othcr Yiolations:
Pancipal's DisPosit10n:
PrincipaVAssist.Pdncipal
Date
dM
DATES OF BEEA OR
N
:
Offtask / daYdreaming
Sleeping / head down Rcfusing to do class work Out of seat
Jewelry
Gang related activity
Other Violations:
-e-1-
<[
PrinCipaVAssist.Principal
RcViSCd 3/6/00
M/1:
ARK
Sy G E
W/H COMMENTS
2
3
4 5 6 7 8 9 0
2 3 4 5 6
WLD GEOGRAPH B B OLOGY I B ALGEBRA IB coMMUNIC APPLIC PERS&FAM DEV B PE FOUIJDATIONS HEALTH ENGLISH I B
TCH TEACHER NAME 406 GABINO R. 308 ALLEN B. 204 BARNES,P. 5 8 BONILLA R. 702 ACOBS C. 508 MCGRUDER K. 507 HARRISON L.
7
D D F
AMAYA A.
ABS 00 00 00 00 00 00 00 00
NO: FUNCT ON CODE: STUDENT F=FORWARD G=GET c=CHANGE GRD D=DROP GRD E=EXIT B=BACKWARD A=ADD -GRADE F =HELP F2=MENU
PRGCRT
OR
N APIE:
41ilTESoFBEIIA
Profanity Talking
do permission
Offtask/ daydreaming
Sleeping / head down
Out of seat
>'
Teacher Signature
Principal's Disposition:
t a1/Assist.Pttcipal
Date
Revised 3/6/00
MIDDLE NAME
0000202272
09
A/C PHONE NO FATHERS WORK MOTHERS WORK COUNSELOR 7 3 363-7 9 7 3-962-6 2 ASSERTIVE DISCIPLINE RECORDS
DISP DAY HOUR DSP
DATE E D DATE TCH LOC TIME
43 04/06/04
DESCRIPTION 02 TARDIES
WARN
H 0720
RSN
33 -9 0-003 CDC 0 ACT 030 RSN INCIDE r 000602 45 04/23/04 53 CDC ACT 000 RSN
r INCIDE
ACT DT 04/07 /04 usER 04/22/04 0]-/04/0s pERsrS DAEP L4 xANAx ADMTTTED To AP AND oFFT oF iTUDENT ITNDER THE rNFI-,uENcE STI'DEMT EXHIBITING BENIGHT. CNN iTTAT SHE TOOK XANAX I,AST USER ACT DT / /
MIDDLE NAME
PERPIANE rI
0000202272
NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 7 3 363-7 9 7 3-962-6 2 ASSERTIVE DISCIPLINE RECORDS
46 04/23/04
CDC
RSN
47 04/23/04
RSN
ACT OOO
CDC
INCIDENT 48 04/ 23 / 04
DISP DAY HOUR DSP DATE ENEl DATE TCH LOC TIME 04/23/04 04/26/04 SUSP WALLS BIJMBING INrO TEACHERS, SLUR HAVIORS OF BUMPING INTO ANOTHER STUDENT A BITCH AND TOLD sPEECH LAUGHING CALLED ACT DT / / USER 04/23/04 04/23/04 CIT rS YOU HOE'S BETTER GET OUT OF MY R00M. OTHER STUDE GH POINT RECOMMENDED AIJD AppROVED BY CITAT10N ISSUED. H ACT DT / / USER
/ /
ACT OOO
INC IDENT
RSN
BURCHFIELD. MOM CALLED TO PICK UP WI] INFORMAT ON WHEN SEH PICKS UP. C ACT DT / / USER RECORD UPDATED E=E D F=FORWD G=GET
L=LAST
MIDDLE NAME
A/C PHONE NO FATHERS WORK MOTHERS WORK COUNSELOR 7 3 363-7 9 7 3-962-6 2 ASSERTIVE D SCIPLINE RECORDS
NO RPT-DATE CDE DESCRIPTIoNDISPDAYHoURDSP-DATEEIID-DATETCHLoCTIME o3/3t/04 O4/O2/ 04 308 G 0945 40 03/31,/04 33 pnucs Levsl 3 susP 3 oN DRUGS,NURSE CoNFTRMS' 'r SEARCH' silrm-ro NURSE,susPECTED CDC puRsE.ADMITS TO TAKING 1/2BAR CS#0403315575 Firvo xeuax rN ACT OO3 RSN INCIDENT 000602 ACT DT o3/3t/04 usER Rr B/3a/o4 o4/o2/04 3oB G 0945 4r 03 / 3]-/ 04 (30 DAYS CFS coN'T DR 40...MOM INFORMED.. CDC ACT OO3 RSN USER ACT DT / / INCIDENT 04/05/04 04/05/04 675 H 0720 WARN ES I TARD 42 04/05/04 02
CDC
RSN
LH
:26:02
sTU# 2322
MIDDLE NAME
NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 3 363-7 9 7 3-962-6 2 7 NE RECORDS ASSERTlVE D SCIPL
DATE END DATE TCH LOC TIME DISp DAY HOUR DSP NO RPT DATE CDE DESCRIPT10N 37 03/05/04 02 TARDIES WARN 03/05/04 03/05/04 675 H 0857 CDC ACT 000 RSN ACT DT 03/05/04 USER LH INCIDENT
38 O3/O8/04 17 rD BADGE
RSN
DET
H 0720
CDC
ACT OOO
CDC
H 0720
ACT OOO
INCIDENT
RSN
ACT DT
03/24/04
E=END
USER LH
DMTS: 30 F=FORWD
F =HELP
G=GET
L=LAST
N=NEXT
X=RSN
F2=ME W
1l-
:26:00
MIDDLE NAME
NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 7 3 363-7 9 7 3-962-6 2 ASSERTIVE DISCIPLINE RECORDS DISp DAY HOUR DSP
DESCRIPT10N
34 0 /23/04
35 03/04/04 CDC ACT 000 RSN INCIDE F 36 03/05/04 CDC ACT 000 RSN INCIDENT
FUNCT ON CODE:
INCIDE r
RSN
02 TARDIES
ACT DT
DATE END DATE TCH LOC T ME / / / / SHE TOLD THE AIDE SHE DID IT IN CLASS. MOM CALLED TO PICK uP. C ACT DT / / USER /81R ]`l /1lREN WAS RE ]`R I TO BTS 3/4 SPOKE TO DEI,ACRUZ TT]RNING TO NSHS. CJ USER ACT DT / /
WARN
H 0720
O3/05/O4
E=END
USER LH
LINE3=DROP C=CHG
F=FORWD
G=GET
L=LAST
Patient info
11
; lnstructions _ nt copy :
1 /
,lime1 8
'
,
,,1
No Sports or PE:
Other:
Restrictions:
S applythm
shOuld be tt 10 panicl
in all SCho
&
the referral physician for further student must return to this facility or make an appointment with NOTE: lf symptoms continue beyond this date, the evaluation.
,rriswei
iy
ippropriate speciatists
and
twittbe
FIRdT NAME MIDDLE NAME PERMANETfl|# SEX GRD STATUS 2322 NAVARRETE KAREN OOOO2O2272 F 09 PARENT/GUARDIAN NAME A/C PHONE-NO FATHERS -WORK MOTIIERS -WORK COI'NSELOR oRTrz, JosE/RosARro 71,3 353-?19L 7L3-962-6112
ASSERTIVE DfSCIPLINE
RECORDS
NO RPT-DATE CDE
2ND TIME COMPACT BROUGHT TO SCHOOL LIED TO TEACHER TIIAT CDC ACT OOO RSN AP IIAD GIVEN IT BACK TO MOM. LEVEL DROPPED TO I MOM SENT INCIDENT ACT DT / / USER 2e o't /L5/04 / / / / CDC HOME INFORMATION REGARD ING CITATTON AND LEVEL DROP. CJ ACT OOO RSN AC.I DT / / INCIDEM| USER 30 01-/28/04 10 PERSTSTENT L2 SUSP 2 0L/28/04 Ot/29/04 CDC STUDEMT CONTINUES TPO SMUGGLE PERSONAL ITEMS IIiTTO CFS AFTER ACT OO2 RSN BEING CAUGHT SEVERAL TTMES BEFORE. THIS TTME SHE }IAD AN INCIDEIIT ACT DT / / USER
28 Ot/L5/04 11
DESCRIPTION DISP DAY HOUR DSP.DATE END=DATE TNSUBORDTNATE CrT 01,/1,5/04 0L/L5/04
FUNCT10N CODE: LINE: DMTS: 30 A=ADD B=BACK C=CHG D=DROP E=END F=FORWD G=GET L=LAST N=NEXT X=RSN ADSCRT F =HELP F2=MENU DATE: 4/23/04 TIME:
,25:54
sTU#
2322
NAVARRETE
LAST NAME
MIDDLE NAME
NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 3 363-7 9 7 3-962-6 2 7 ASSERTIVE DISCIPLINE RECORDS
/23/04
32 0 /23/04
DISP DAY HOUR DSP DATE END DATE TCH LOC TIME / / / / ANKLE BNRACLET ON COVERED wITH HER SOCKS. WE NOW CHECK ALL SHOES AND SOCKS . SEVERAI-, STUDErS HAVE BEEN CAUGHT WITH ITEM USER ACT DT / / / / / / IN THEIR SOCKS. DESCRIPT10N
USER ACT DT / / oa/28/04 oL/ 28 / 04 GANG ACTIVITY CIT HANDS SHE HAD GANG RELATED DRAWING ON AFTER CHECKING KARENS ALL OF HER K UCKES ON HER HAND.WHEN ASKED WHEN SHE DID USER ACT DT / /
INCIDE F 33 0 /28/04
RSN
E=END
F=FORWD
G=GET
4/23/04 TIME:
KAREN
FIRST NAME
MIDDLE
NAME
OOOO2O2272
09
oRTrz,aIosE/RosARro
NO RPT-DATE CDE
NAME
ASSERTIVE DISClPLINE
MOTHERS-WORK COT'NSELOR
DESCRIPTION DTSP DAY HOUR DSP_DATE END_DATE TCH LOC TIME 71./:8/03 O!/O8/04 s0 H O72O 22 1,7/74/03 33 DRUGS LEVEL 3 CFS 20 XANAX INFLUENCE IJNDER THE STUDENT ) 101-910-003 CDC ISS PENDING PLACEMEIiTI MOM, W. CITATION RSN CONF. #52581, ACT O2O ADL DT tI/1.4/03 USER ACT INCIDE}IT v'/1'8/O3 1'1'/78/ 03 s0 H O72O 23 LL/L8/ 03 09 OTHER LEVEL 1 rSS L 1"1-l20l03 PTACEMENT, CFS ORETNTATTON PENDTNG cDC 101-910-003 ACT OO1 RSN ACT DT 71/1,8/03 USER ADL INCIDEIiTT L2/1,2/03 t2/1'5/O3 24 L2/L2/03 09 OTHER LEVEL 1 SUSP 2 IN CI,ASS PASSED IT TO ANO?HER WROT A NOTE DISRUPTION CLASS CDC AFTER SCHOOL MOM CALLED DRUGS CONCERNING STI'DE}III COIiII|ENTS ACT OO2 RSN DT USER ACT INCIDENT / /
(
FUNCT10N CODE: LINE: DMTS: 30 A=ADD B=BACK C=CHG D=DROP E=END F=FORWD G=GET L=LAST N=NEXT X=RSN ADSCRT F =HELP F2=ME U
sTu# 2322
MIDDLE NAME
PER VttJENTI
o000202272
ORTIZ OSE/ROSAR 0
;]];::]:91' 4: :::YttI
NO RPT DATE CDE 9 /06/03 02 CDC RSN ACT 00 INCIDE 20 / /03 0 CDC ACT 000 RSN INCIDEIJr 02 2 / 2/03 CDC ACT 000 RSN INCIDENT
DISP DAY HOUR DSP DATE END DATE TCH LOC TIME DESCRIPT ON /06/03 H 0720 /06/03 SUSP TARDIES 6TH OFFENSE:SWEEP ACT DT /06/03 USER RI FDH PERSISTE r L2 cuT IN LtINCH LINE LIED ACT DT TARDIES ACT DT
/ /03
045
/ 2/03
/ 2/03
675
H 0720
/ 2/03
E=ENEI
G=GET
L=LAST
ADSCRT
DATE:
4/23/04 TIME:
:25:46
MIDDLE NAME
A/C PHONE NO FATHERS WORK MOTHERS WORK COUNSELOR 7 3 363-7 9 7 3-962-6 2 ASSERTIVE DISCIPLINE RECORDS
HOUR DSP DATE END DATE TCH LOC TIME DISP DAY NO RPT DATE CDE DESCRIPT10N 045 0/22/03 0/2 /03 ES ISS 2 0/20/03 02 TARD 6 5TH OFFENSE CDC 0 -9 0-003 ACT 002 RSN ACT DT 0/20/03 USER R] INCIDENT 50 0 200 0/29/03 0/27/03 TRUANCY-3 UABS ISS 3 7 0/27/03 06 MOM r. CO PICKED UP BY DEPUTY AT R.ALAMAZANiS HOUSE CDC 0 -9 0-003 cITAT10N # ACT 003 RSN ACT DT 1.0/27/03 usER ADL INCIDENr 0740 to/2e/$ a0/30/03 823 flliueoRDli{arh susp 2 8 0/29/03 ut/TNSTRUCTToNS: oisnuptrou rN Tss,REFUSUAL To coMPLY CDC CIT#52371 TODAY REMOVED REMOVAL, DR ON 10-28,BII| NO ACT 002 RSN Rr ACT DT 1O/29/O3 USER INCIDE DMTS: 30 FUNCTION CODE: LINE: N=NEXT X=RSN E=END F=FORWD G=GET L=LAST A=ADD B=BACK C=CHC D=DROP F =HELP F2=ME W
ADSCRT
DATE:
4/23/04 TIME:
:25:44
FIRST NAME
KAREN
MIDDLE
NAME
oRTrz,JosE/RosARro
NAME
ASSERTIVE DTSCIPLINE
NO RPT-DATE CDE DESCRTPTION DTSP DAY HOUR DSP.DATE END_DATE TCH LOC TTME to/02/03 to/03/ 03 505 E 104s rSS 2 1,3 1,0/01,/03 09 OTHER LEVEL 1 CLASS. PERIOD AGAIN. GAI]DET'S TRUA.I{T SEVENTH CDC 101-910-OO3 BACKI,ESS SHOES. ALSO, WEARING ACT OO2 RSN USER SM ACT DT / / INCIDENT to/08/03 to/08/03 67s H 12s3 DET TARDTES L4 to/07/o3 02
CDC
ACT OOO
CDC
RSN
1'0/17
ACT OOO
INCIDENT
RSN
ACT DT
IO/1,3/03
USER LH
DMTS: 30 LINE: L=I,.AST N=NEXT X=RSN A=ADD B=BACK C=CHG D=DROP E=END F=FORWD G=GET F ADSCRT =HELP F2=ME U FUNCTION CODE:
I
sTU
MIDDLE NAME
PARENT/GUARDIAN NAME ORTIZ OSE/ROSAR10 NO RPT DATE CDE o 09/25/03 09 CDC ACT 000 RSN INCIDE 7 09/29/03
NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 3 363-7 9 7 3-962-6 2 7 ASSERTIVE DISCIPLINE RECORDS
DSP DATE ENEl DATE TCH LOC TIME DESCRIPTION DISP DAY HOUR 230 0/03/03 506 E 0/03/03 oTHER LEVEL FDH SKIPPING GAUDETiS CLASS. GAUDET SAW HER IN CAFETERIA. BRING CO SERV. NFO AS REASON FOR MISS DET AD ACT DT / / USER SM 0720 oe/2e/03 oe/2s/03 1D BADGE WARN
ACT 000
2
CDC
INCIDE r
RSN
7
09/30/03
H0720
USER LH F=FORWD
G=GET
L=LAST
DATE:
4/23/04 TIME: 1
:25:4
MIDDLE NAME
PERMANENT# 0000202272
MAILING ADDRESS
STATE TX
ZIP CODE
GRID+ A/C HOME PHO EMERGENCY PH/EXTN 7 3 363-7 9 7 3-962-6 2 CELL HRM LOCAL CODES E/C S/E MSG AR H
RNG TRK LS ENrER DT W/D DT 42 03/ 3/03 / / O-9 PRIV ENTR 9TH LYC 08/ 3/03
SOC SEC llUM ALT ST ID LAST/PEIM GEN D _ S 69655 6 NYC NYA BIRTH CITY
RESERVED
LAURETINO MATA E=END F=FWD G=GET N=NAME CHG P=PRIIT V=V E X=SWTCH F =HELP F2=MENU
FIRST
KAREN
NAME
MIDDLE
NAME
COUNSELOR
13ME
AS:::T:;: ON
::::.:::I: ::::lis :: DAI HOUR :3 1:'3: : 1:'I] TCH LOC TIME 8/03 09/ 8/p3
Rg] :T
::;18;:!
[::
09 8I::ILEY(L.:s
:i:::. 9/.809/
1 0835
0857
DT 09/ ACT 00 RSN 8/03 1NCIDENr ACT IES SUSP USER 2 ADL 9 o9/22/03 02 TARDoFFENSE 8TH CDC ACT 002 RSN ACT DT / / USER RI INCIDE r
g31
9/22/03
09/23/03
: c=cl[NE3=DROP
=:18
E=El D
F=FORWII
G=GET
ADSCRT
DATE:
4/23/04 TIME:
125:39
MIDDLE NAME
NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 7 3 363-7 9 7 3-962-6 2 ASSERTIVE DISCIPLINE RECORDS DISP DAY HOUR DSP DATE ED DATE TCH LOC TIME
4 03/29/03
02 TARDIES
FDH
09/05/03 09/05/03
0857
ACT DT / / USER LH ISS 2 TARD ES MOM INF. 3:49 PM TARDY ACT DT / / USER SG DRESS CODE ISS 4 MOM COFACTED 9/ 6
ACT
H0720
0800
Dr 09/L6/03
USER ADL
E=ENEl
F=FORWD
G=GET
L=LAST
/ 23 /
04
TIME
11 '- 25 :37
:]
SEX F
78950 PERS&FAM DEV A 0250 ENGLISH I A 8 5000 TEEN LEADERSHIP 2 150 ALGEBRA IA 75 000 FLORAL DESIGN 402501 WLD GEOGRAPH A 512501 PHY ED I1/GIRLS 31350 BIOLOGY I A
TCH TEACHER NAME 702 ACOBS C 7 m4AYA A. 5 3 CALLAHAN A. 204 BARNES P. 608 LATKA K. 406 GABINO R. 506 GAUDET G 308 ALLEN B.
ABS 00 00 00 00 00 00 00 00
X83:8NA::DE
BACKWARD
PRGCRT
STUDENT C=CHANGE GRD D=DROP GRD E=EXIT F=FORWARD G=GET Fl=HELP F2 MENU
DATE:
9/15/03 TIME:
9:25:36
`4
64
/+TlB dtro
/
qbl
:3
1 (g
N ]
I::[;181E
A`L ::,:],:
E : :IE
ATE
IEA
FRIDAY WEDNESDAY THI]RSDAY TUESDAY MONDAY DAY DAY S01-234567 89 S012345578! DAY S0r-23455789 50123456789 DAy S0123456789 DAy HOLIDAY 10/31 10/30S SSSS---ao/295 rrrl-------ISSS ao/28r L0/27A ----AArr 1l-l07 L1-/06A AAAA---------AA 11l0s Lr/o4A -A-----1,1,/03 t1-/ 1-4s ssss---11ll-3 T-A----ta/L2 -------Ll/ao -------- tt/11, ----cccc tr'/r7s ----ssss tt/L8r rrrr---- Lt/a9c ----cccc LL/2oc cccc---- LL/2rcHOLIDAY HOLLDAY rL/28 Lt/27 LL/26 HOLIDAY HOLIDAY L1l24 HoLTDAY 11125 t2'/olc TCCC---- L2/O2C ----TCCC ]-2/O3C CCCC---- L2/O4C ----CCCC 1'2/O5C CCCC---12/OeC ----CCCC 1-2/osc CCCC---- L2/]_oC ----CCCC L2/L7C CCCC---- a2/L2C ----CCCC 12'/ass ssss---- t2/16c ----cccc 1,2/t'lc cccc---- !2/18c --c---c- 12119 HoI-,rDAY L2/22 HOLIDAY t2/23 HOLIDAY t2/24 HOLTDAY L2/2s HOLIDAY !2/26 HOLIDAY t2'/2g HOLTDAY 12130 HOLIDAY 12131 HOLIDAY 01/01 HOLIDAY 0u02 HOLIDAY
PERIOD ATTENDANCE
I=ISS
/ THRU: / CODE: ALL: CODE: DATE: CHANGE END FORWARD GET LAST NEXT PRESENr TOTALS UNDO XFER BACKUP F =HELP F2=MENU ATPCRT DATE: 4/23/04 TIME:
: 8:47
:3
1 1
NAVARRETE
LAST NAVIE
]: [;18TE
Eu
,1: IE LE IE ,ATE
THURSDAY MONDAY TUESDAY WEDNESDAY FRIDAY DAY S01-23456789 DAY S0123455789 DAY S0123455789 DAY SO 23456789 DAY SO 23456789 - 03/22 08,/18 -------- O8/19 -------- 08/20 08/2 08/2sr -----T-- 08/26 T-A----- 08/27A ----AAAA 08/28A AAAA---- 08 / 29"t ----TT-09/01 HOLTDAY 09/O2A AAAA---- 09/03A ----AAAA 09/04 -------- 09/05 09/088 EEEE---- 09/09 09/r}r rrrr---- 09/aaE ----EEEE 09/L2T Trrr---09/75O ----AOSS 09/L6T rrrr---09/1,7r ----rrrr 09/1"8S SSSS---- 09/l-9 09/2s ------AA 09 / 25E, EEEE-_-09/22T -TSS---- 09/235 ----SSSS 09/24 09/29O -----O-- 09/30A TAAA---- 10/01 ------A- to/o2T rrrr---- 10/03A - - - -AAAA to/06r Irrr---- 10/07 ----A--T 10/08A AAAA---- 10/09A ----AAAA 10/10A AAAA - - - 10/t3 ----T--- r0/a4A AAAA---- 10/15 70/t6 A-A----- L0/L7E - - - -EE- 1,O/23 L0/2L LO/22r rrrr---to/20 --T----------A- lO/24 A------A=I]NX B=BUS C=CFS D=DOC E=EXC
PERIOD ATTENDANCE
I=ISS
s=sus
T=TDY
CODE: DATE: / THRU: / CODE: ALL: FIRST DAY ALREADY DISPLAYED BACKUP CHANGE END FORWARD GET LAST NEXT PRESENT TOTALS IINDO XFER ATPCRT F =HELP F2=MENU DATE: 4/23/04 TIME:
: 8:40
7AD'N KAREN
FIRST NAME
MIDDLE NAME
0000202272
;iiil;;Jo;;iiosanro
CDC ACT 000 RSN INCIDENT
PARENT/GUARDIAN
NAIvtE
A/C
2 08/26/03
RSN
02 TARDIES
ACT
USER LH WARN
0720
CDC
ACT OOO
iucroeur
DT / /
usER LH
:;: :iu E FI
DMTS: 30
DATE:
4/23/04 TIME:
:25:34
i l
:III
: '1= =
=:i
F d 54 lP`
7
`:
Assessnrcu.t
$rantefr
{name,
titkJ
Student D eEIMS):S16965516
Local Student D:oooo202272
D
1.Bask Undersmnding.
Class Croup:LRBANOVSKY F
EMS
2
No
3.Usin=StratttLs tO Analtte.
14
TOTAL l'7111114'111
rrir roo
1500 l?00
le00 | rtoo
2300
23)0
Score 0f 2{00
Grnde
3
1.Numbe ,Operalons,and
Quandtative Reasoning
Algeb ic Reasoning.
SPRING 2003
2210
YES
2.P tterns,Relatlonships,ond
8
6
10
7
2
5
5
8
5.P babl w
and St
stics.
10
CoDD.Dded Perlom.rce: Sql Score of 2400
SdL SoR
Met SEDdtrd
: CoriEeded PrfbrBlue
2 2
6 9
2
5
3
l$o
TOTAL II ,11: 14,I
tino
19oo | 2loo
20
23oo
2700 2 7_ 'i.
Document# 574443796-27675
For more inforrnation about the TAKS tests, contact your child's school'
Print# 3 6732-079
I want to take this opportunity to tell you how to sign up for choir in high school for the coming school year. You will receive a schedule request form from our counselors. All you have to do ii circle Choir. Even if you have no experience you can become a part of our organization- If
you havc experience singing please drop by and visit your middle school choir drrector. T'hey can i.ro*-rnd you for one of our upper level groups. Now is the time to sign up and enjoy all that high school choir has to offer You. The North Shore High School Choral Department is the largest organization on campus with more than three hundred students involved in ten ensembles. Our choirs take a trip every year to a choir festival and visit places like Austin, San Antonio, Dallas and New Orleans. After the contest we have spent the day al Fiesta Texas, Six Flags, Seaworld, Schlitterbahn and the French Quarter in New Orleans. Last year our varsity Chorale spent an entire week in Washington D.C. Our choirs are very successful. North Shore students have won more than 1500 medals at solo and ensemble as well as placed nearly 500 singers in Region, Area, and All-State Choir. North Shore Choirs are awarded hrst division honors at UIL and national choral festivals' North Shore Choir members are the most active and involved students on campus. Choir members are officers in every club and organization. You can be in choir and honors classes (the valedictorian or salutatorian were bothfour year choir members in 1992, 1994, 1995, 1996, 1997 and in lggg), choir and band (in ;,993 we had an All-State tenor who played the sax in 1996 an AllState Bass played percussion),.choir and athletics (football, baseball, soccer, volleyball, golf, tennis),choir and cheerleader (squad leader in 1997, 1998 & 1999 and head cheerleader in 2002), choir and student council (Student Council President 2002), or choir and Scarlets ( Co-Captain in 1991, 1998 & 1999 antl Captain in 1995 & 1996). Choose success, fun, greai dmes, ftien<iships anti a high schooi exper'ience you'li never forget. Excellent music, exciting trips, and great new friends are all waiting for you in the North Shore Choir. I'm looking forward to seeing you in the high school choir.
Sincerely,
Enrique Collalo
/.1 ,,k't'/-r 1/ /
k:
tn)
C EM 2 E
aaa.a
11:
, .
STORY REylsED fO Section Four:PREPARTrCF TJo PHYS CAL EVA T10N MED C e sltrcrenf fO parfcrpare rr a rr1 0der SrORY FORH m sf be compreled a J by paFrf ror g arla a d sfudenf js MEDrCAL fe ar attreflc eve t azad IJs fo pa
fo deremrre rftte sfuderf as developed ary c diO lCa wOtrld mate r
4- 2
7bese
"
SASI Nulnber
Physician
Phone
RelationshiP,
q
Phone(H)
(1
V)
S arswer
YES
Have you had
NO
medical illness
10.
1.
Have you had any problems with your eyes or vision? Are you missing any paired organs?
check up or sports Physical? Have you been hospitalized ovemight in the past year? Have you had surgery in the Past Year?
Do you use any special protective or coneclive equipment or devices that aren't usualty used for your sport or position (for example, knee brace, speoal neck roll, foot orthotics, relainer on
)rour teeth, hearing aid)?
pills or using an inhaler? lover-tne-counter) medication or do you have any allergies (for example, to pollen, medicine' food, or stinging insects)? Have you ever passed out during or after exercise? Have you ever been dizzy during or afrer exercise? Have you ever had chest pain during or after exercise?
or swelling
in
loi9Pl
of your heart or
skipped
boy'nd
explain belorr:
heartbeats? Have you had high blood pressure or high cholesterol? Have you ever been told you have a heart murmur? Has any family member or relative died of heart problms or of suddln unexpected death bebre age 50? Has any family member ben diagnosed -wilh enlarged neart, hypertrophic cardiomlopathy, long .QT syndrome' Marfan'slyndrome, or abnormal heart rhythm)? severe viral infeclion (for example, Have you had myo"ariitis ot mononucleosis) within the last month? His a physician ever denied or restric'ted your participation
{r
tr Shin/Calf O Ankle
+.{. 15.
Do you want lo weigh more or less than you do now? Do ),ou lose lveight regularly to meet weight requirements for your
IE1/
sporE
Tetanus
bel stressed out? Record the dates of lour most recent immunizations (shots) for: Measles
Do you
ChickenPox
Femalet Onlv:
When was your first menstruel period?
memory?
When was lhe last concussion? Ho$/ severe was each one? (Explain) Have you ever had a seizure?
\Mat was the longest tirne betureen periods in the last year?
B/.
Explain'Yes' answers here (A yes" on guestions !, 2, 7, 11 or 17 requires a tuiher medicat evalualbn which may inctude a physical examination. wilten clearcncefrcmaphpician,physicianassisranl,ornurr,eilactitionerisrequired
before any padicipation in UIL pnctices, games or matches.)
of
breath wilh
medical
tl O
though
SoFTBALL
w ilE
iatacaleandteatnentasaEsutlotanyiniuryorsickness, Idohercby rcguest, ff,inthejudgfi,antofsnyrcrr,er;rlntatueofthescllcl],t'lheabo|Edudentshouldndimne4i pnysician, frainer, nurse or schoo, rPptesentative. I do hercby agre to indemnW and
the univetsity
'lveither
Ji xuaent oy any aN rreafrrenl as ,av u'iii grA n n*pt t,epi*n6lw mn any ctain iy aiy 1p,6,on on a@unt ol sudr arc and trcati'nt of said $t&n1 ',lt61;l tinil this stdenrs ,xa/rtrit,tion, I agree to notily the sch@l fi, betuw,en llrls da{e and the bqinning ol athldic con',f,tttiut, any iltness ot tniur should o6ar that may authotities d s,rch iltne$ o( inw.
aN
to
such care
am aiy
nereby
Sfa
,t
fO tte
F RST NAME
MIDDLE NAME
ORTIZ
/02
PAGE
DATE PAID / / / / / / / / / / / / / / / /
oF
DATE
4 5
6
7
8
TOTALS
50.50
.00
50.50
l:
J( ^ ffF `
`CX)
KX J e
alL
=
l f
Cer: Li l'icate
of Complel"ion
lhat.:
kapeN
11
N,t't*
<tel-r
SS as()r(lcl o(ll)y lllc itl(18C lll llto
3(`):
(:1()(1l11()811()1: ,()
A lll:cr Mallagoinont C
R-910 2
25B
ond
Of
C NGRATULAT] NS
t0
Koren Novorrete
on successful completion of Elementary School and Promotion to Middle School'
Knowledge unlocks the keys to power' Leorn so you hove the Power lo chonge the world You live in.
Slole Representolive Signed under the seol ot lhe Stote Copilol in Auslin, Texos Moy 2000
:1:,1
L O
C O
L
0 D
% %1
EN
AVARRE
ffom" t
is hereby'pro"moted
FIFT 16RA
Awa\rded
r, R. P HnRRsschoor
layof rhir\ed
Mav
year:f2b9o0
NO VA5090 COPYRGH
1998
HNES SCH00LPUBuS
NC CO NC RGH
W d
}1 2
!(
9 o5
`RIN '
'lRITT=, 9/11/ A
1
Palent iD
hclructlonr:
1.
2. 3.
4
Check or mark items to be dispensed: only quantitie6 in preprinted boxes wii be dispensed' Wrltc number of ltemr ordered ar r rvord (lc onc for I ltem, two lor 2 lteml, ctc.). Emboss this form with patient lD plate and station number. pationt will adminisler medication as directed on label or as directed by physician. Do not wrltc lnclructlonr on thlr lhcct. Aflentlon pedl: For patient under two (2) years old, the physician chould explain verbally, or prelerably in writing to the person accompanying the patient, tho dosing insbuctions lor oach drug prescribed, bocause dosing instructions lor all ages may not bs on tho packago labol.
5.
Amount
Dispensed
COde
(Prefi1 425 )
De
:
1::l:1: 1
Acetarninophen 325 mg T
Acetarninophen 500 mg Caplets 50'S A!uminum Acetate Effervescent(Domeborol Tablets No.30
121
121
16-O
0158-l
[11- 121
lll
11l
121
P1
9712 l
0442 4
7077-O
Asp
[ll
121
0485-8
H 1ll 121
1ll 121
8622 6
i1 t 3 I
8331-6 BO"Lotion 240 rn1 8ottie
]
Btte
:s
r. (:
[1l
Pl
1923-5
19501_
= 9772 4 F9rrOuS purate 325 mg T Ferrous Surate Drops 50 ml BOttle . 2517 O 8275 l Guaifenesin w/Dextromethorphan Syrup 120 ml Bottle Hydroconisone o.5%Crearn 30 gm Tubel 8773 7 8774-5 HydrOconisOne l%Crearn 30 gm Tube Lancet Refi 200's 0486 6 8363-4 Mg.AI.Hydroxide w/Simethicone(Maa10x Plu Myianta )SuSpension 150 ml No.5 BOttles
,od,Sd'SuCdnd
l mgl
4618 6
lll
12]
6303-O
9909-3 Prenatal Vnarnin Tab!ets l 5943-l PSeudoephedrine Syrup 120: l BQttle 9945=Q Saline Nose Drops 15 rnl BOttle
ID
:
281098(1/031
Of s6/gz
.WOODLA
tD ACRTS TLTjvtTj,tTARy
-74a-..-, Pa-r-rq,
FRANCES RAMSEY, PRINCIPAL
hroy.
8, tgg6
225C m29
KAREN NAVARETE
ST"f
27, tgg6
9b
iZ 9
T L N HH03
11
11
91 }
ril 11-t
) ti 11111
lI
1 i) 113 11 VIAl tl 11 1' 1 A ` / 131'1lJ 1 ' lI ll rI 1.HC11 1 H , ]Hl_I All llSunH 1- =`) ` u _J J3v 5 1 3J.H 1 d li(II AC)ud SV 1 =:[ V ] J 13 11'1 ti C)1. IV 3 V 1 1 H .1 1.3 1
1
ll
V "1 :31u
11
61-
`::
'11
1 1
111 V
'1
:1.
NO t JlB
JI II
13 _4 Hi Ji 1 1
1
SG
[1 I
10
1 :
1
i$.1 Hi tJ
'1 ](1
11 , 7 t 11
l
lC 6 )'
9111
I.l
NC)
1 E lt
{::
'111..
11)
1 1 11
NIZAT10N RECORD
lX)()8
I
RE(
61
:
RS
1}
_____
t,
"
(Mltlltl.l:)
l.l
('
(:Ll,
1)
RECORD oF ATTENDANCE,SCHOLARSHIP
AND R ESIDENCE
51
116
t 1
}
/ k
-1
tBApINE
E XCEI.1 ENT
A-90-100-
XCEI 1 ENT
3RD CR^0'