CASE TITLE _3_ plaintiff ________________         DATE REC'D: 11/12/13
       vs. _4_ defendant ________________           ATTORNEY: 14_ attorney__
     SERVE _5_ serve address line 1 _____              COURT: 5C 16_ court co_
           _6_ serve address line 2 _____              CASE#: 17_ case num_
   ADDRESS _7_ address served line 1 ____           DOCUMENT: 18_ document 1
           _8_ address served line 2 ____             MATTER: 19_ matter____
           _9_ address served line 3 ____
           10_ address served line 4 ____
PAYMENT #1 AMOUNT     3.00    DATE 12/34/56              37_ PROCESS__     0.38
COMMENT comment field, like check number --|             39_1STADDRESS     0.40
                                                         41_2NDADDRESS     0.42
PAYMENT #2 AMOUNT  0______    DATE   /  /                43_3RDADDRESS     0.44
COMMENT                                                  45_RUSH______     0.46
                                                         47_MAILING___     0.48
           PAID TO DATE     3.57                         49_COURT SERV     0.50
           BALANCE DUE      1.13   STATUS: OPEN          51_ROUND TRIP     0.52
                                                         53COPYOFPROOF     0.54
                                                         55FEEADVANCED     0.56
POZZI WILSON ATCHISON
1400 STANDARD PLAZA                                      SUB-TOTAL         4.70
1100 SW SIXTH AVENUE                                     PREPAID           0.57
PORTLAND OR  97204                     CLIENT 81101      TOTAL DUE         4.13
                                                         INVOICE NO.   1001
DATE BILLED   /  /