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Chapter 1

Form 1-4

Payment Record

Case File Number:

Debtor:

Attorney Responsible:

[Forwarder:]

Date File Opened:

Creditor:

Payment record

To attorney

To client

Amountre­ceived

Date received

Check #

Add’l charges

Balance owed

Remarks

Fees

Costs

Other

Amount

Check #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Make a tickler for the next date when payment or receipt of other proceeds is expected.