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Ennio Diaz Attorney at Law 5615 Richmond Avenue, Suite 250 Houston, Texas 77057

USCiS
P.0.Box 660045
Da as,1)(75266 0045

Compl to ltOm3 1,2,and 3.Also completo

A Stnatu

or1 4 r RosuctOd Dellvery 19 deslred. Prlnt your nalne and addmss on he reverse
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' Da as,TX

75266 0045

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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

::102L L 01: L LL 555L0 7L]7


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OMB No 1615 0105:Expircs 04/30/2012

G 28,Notice of Entry of Appearance

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:

B. I hereby enter my appearance

as attorney

or accredited representative at the request of:

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.

Principal Petitioner, Applicant, or Respondent Namc: Last


Ilirst

A Number or Receipt
Middlc Number, if any

! I I

Petitioner

NAVARRETE

KAREN

MATA

Applicant
Respondent

Addrcss: Strcct Numbcr and Strcct Namc

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.

Signatdre g\Petitionqr, App lica nt, or Respo n dent

Date
2-28-2012

rmation about Attorney or Accredited Representative rC


A.

,pp s ,
`

tr

I am an attorney and

a member in good standing

ofthe bar ofthe highest court(s) ofthe follorving State(s). possession(s). territory(ies),
TEXAS

commonwealth(s). or the District of

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.

Name and Signature of Attorney or Accredited Representative

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

5615 RICHMOND AVENl E SUITE 250 HOUSTON TEXAS 77057


Phonc Numbcr`
(713)581 7051
`

c Ftt Numbcr,ifany tt (713)493 7211

INF00HOUSTON DA.COM
Form G-28(Rcv 04/22/09)N

OMB No 1615 0040:Expircs 04/30/2013 Department of Homeland Security


1

765,Application For

Do not write in this block.


Remarks

Action Block

Fee Stamp

A#

Applicant is filing under $274a.12

lApplication

Approved. Employment Authorized / Extended (Circle One)

until

(Datc)
(Dratc)

Subject to the following conditions:

Hsh Fdd

du undcr 8 CFR 274a12(o or(o

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:

Pcrmission to acccpt cmploymcnt

sl O O Rcplaccmcnt ra/ to acccpt cmploymcnt Rcncwal ofmy pcrlnission


C E:_^ (First) L Name (Family Name in CAPS)

/2
`

: !_ (Middle)

WhiCh lJSCIS Ottce?

S 0 9 Datc(s) Dal
7_ `

NAVARRETE KAREN NAVARETTE

KAREN
ONES

MATA
Results (Granted or Denied - aftach all documentation)

2 0ther Names Used llnCludc Maldcn Nalne)

3 Addrcss in thc United Statcs(Strcct Numbcr and Nalnc)

(Apt. Number)

13213 KNOLLCREST STREET


(TOWn Or ci
)

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

6 Datc of Birth (mttd

09/21/1988

I va. lE re.ul"
E
oirlo,..o
)

E wiao*.0

under 8 CFR 274a 12( c

) (14

)(

9. Social Security Number (include all numbers 1ou have ever used) (ifanr

10. Alien Registration Number (A-Number) or I-94 Number

(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

Y", (lf "Yes,"

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

Sigizitirre of Person Preparing Form, If Other Than Above:


5615 Richmond Ave,Ste 250

Ennio

Houston

TX77o57

12/28/2012

Datc

Form 765(Rcv 0425/12)Y

Fornl I-765 Worksheet


Department of Homeland Securi
U.S.Citizenship and lmmigration Se
ices

Forlll I

USCIS 765WS

OMB No 1615 0040


Expircs 02/28/2013

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.

Part l. Full Name


1.a.

Family Name (Last Name) Given Name

NAVARRETE KAREN

1.b.

(First Name)
1.c.

Middle Name MATA

Part 2. Financial Information


2.

My current annual income is: My current annual expenses are:


The current value of my assets is:

3.

5000
0

4.

Part 3. Additional lnformation


Ifyou would like to provide an explanation ofthe above infbrlnation,please use the space bclow.

I WOULD LIKE TO BE
EDUCATION

APPROVED FOR DE ERRED ACTION SO THAT

I MIGHT CONTINUE MY COLLEGE

Fom I 765 VS Vorkshcct 08/15/12

Page

I of

Consideration of Deferred Action for Childhood Arrivals


Department of Homeland Security
U.S. Citizenship and Immigration Services

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

Fill in box ifG-28 is attached to represent


the requestor.

Attomcy Statc Liccnsc Numbcr:

24028299

START HERE - Type or print in black ink.

Part 1. Information About You


I am requesting consideration ofdeferred action for childhood arrivals undlhave included Form I-765, Application for
Employment Authorization, and Form I-765WS, Form I-765
Worksheet.

Remov al Pro

ce

din g s I nfo

rmation

3.a.

Are you now or have you ever been in removal


proceedings?

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

! !

Terminated Subject to a Final Order

1.c.

Middle Name

MATA

3.c.
Mailing Address
2.a.In Care ofNarne

Date and Location of Proceedings

2.b.

Street Number and Name

3213

KNOLLCREST STREET

2.c.

ept. !

Ste.

tr

Flr.

tr
770 5

2.d.

City or Town

HOUSTON

2.e. stut, ltx-l

2i. Zipcode

For USCIS Use Only

Fol

ll I

821D 08/15/12

Page

I of6

Part 1. Information About Yort (continued)


Other Information

15.Status at Entry tt g,32,F

Sr s, , ,

EWI

ENTRY WITHOUT INSPECTIttN

16.a. Do you have an Arrival/Departure Record (l-94)?


A

4.
5.

Alien Registration Number (A-Number)(rf ary)


16.b.

!ves XNo
List your I-94 number /
>
17.

U.S. Social Security Number >

(l

any)

Date authorized stay expired, as shown on Form I-94,

Date of

Binh

(mm/dd/yyy)

09/2

988

I-95, or I-94W (if applicable)


/

7.

Gender !vtale IFemale

"

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)

HIGH SCH00L GRADUATE


Name, City, and State of School Currently Attending or Where Education Received

mRQUE LEARN NC CENTER HOUSTON TEXAS


10.

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

Military S ervice Information


21.a. Were you a member of the U.S. Armed Forces or Coast
Guard?

Other Names Used (including maiden nome)


If you require additional Information.
12.a. Family Name
(Last Name)
space, use

Part7., Additional

!Yes

XNo

If you answered "Yes" to the above question, you must provide


responses to Item Numbers 21.b. through 21.e.

ONES

12.b. Given Name

(First Name)

KAREN

21.b. Military Branch

12.c. Middle Name NAVARRETE

21.c. Service Start Date (mm/dd/yyy)

as
13.


/ > 03/06/ 995 , >

21.d. Discharge Date


/ ,

Date of r Entv into the United States,on or about:


21.e.
`

14.

into the United Statcs.

` `

For USCIS Use Only

orm l 821D

08/15/12

Page 2

of6

art 2. ArrivaUResidence Information


I arrived in the United States on or before June 15. 2007.

Address 2

l.a. l.b.

4.a.
4b

Dates at this residence (mm/dd[yry)

ftves Euo
I have been continuously residing in the United States
since at least June 15.2007.

From:) 03/ 5/2005 r[


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.

Dates at this residence (mm/dd/yy.v)

From:)

/02/2003
322

To:

) 03/15/2005

Additional Information.
Present Address

Street Number and Name

KNOLLCREST STREET

5.c.

2.a.
2.b.

Dates at this residence (mm/dd[y.v1'1

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

Information. 6.a.Depanurc Datc l / 6.bo Retum Date l "

2.e.

2.f. Zip Code 77015

Address I

dal)>

",

3.a.
3.b

Dates at this residence (mm/dd$yy.v)

6.c.

Reason for Departure

From:) 01/0 /20 0


Street Number and Name

To:

0/30/2012
7.a. Departure Date 2 ` /

550 NORMANDY STREET

3.c.

Rpt.

ffi

Ste.

tr

Flr.

tr

25 2

7.bo Retum Date 2

rF7 /d

3.d.

City or Town

HOUSTON
ZpC C 770 5

7.c.

Reason for Departure

tte

For USCIS Use Only

FoHn l 821D

08/!5/12

Irage 3 of 6

Part 3. Criminal, National Securify and Public Safety Information


If any of the following questions apply to you, use Part 7 ., Additional Information, to describe the circumstances and include a full explanation.

Part 4. Signature of Requestor


Requestor's Statement (check one)

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

uestor's C ertific atio n

I certifu, under penalfy of perjury under the laws of of the


Have you ever been arrested for, charged with, or convicted of a crime in any country other than the United

States?

lVes

XNo

If you answered "Yes" you must also include copies of


all arrest records, charging documents, dispositions
(outcomes), sentencing records, etc.
3.

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.

Date of Signature (mm/dd/y171

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.

Acts involving torture, genocide, or human trafficking?

! 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.

Severely injuring any person?

[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?

knowledge, and that the information is true to the best of my knowledge.


7.ao Si

[Yes
Preparer's Full Name

ENo

of Preparer

7.b.
(lasl
trr,

Date of Signature (mm/dd/yyyy)

2/28/20 2

Provide the following information concerning the preparer:


2.a.

s Family Name

Part 6. Signature of Interpreter

2.b.

Given Name (First Name)

3.

Preparer's Mailing Address

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

5615 RICmOND AVENUE

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.

Preparer's C o ntact I nfo rmation


Daytimc Phone Numbcr(
Email Address

Name (Iasl Name)

)[ 7051

3.b.

Inte

Given Name 'First Name)

INFOCHOUSTON DA.COM

For USCIS Use Only

FoHn I 821D

08/15/12

Page 5

of6

Part 7. Additional lnformation


If you require more space to provide any additional information
within this request, please use the space below. If you require
more space than what is provided to complete this request. you may use a separate sheet(s) of paper. You must include your full name on each sheet of paper along with the page number, Part Number, and Item Number related to your explanation.

3.a.

3.b.

3.c. Item Number

3.d. cAsE No. 2oo4-o32L3J KAREN MATA NAVA

DELrNeuENcy,

TE WAS ARRESTED ON
N

MARCH 3 2004

HARRIS COUNTY

TEXAS

FOR POSSESSION OF A CONTROLLED

SUBSTANCE ALPRAZOLAM LESS THAN 28 Your Full Name


1.a.

GRAMS AND CHARGED WITH A CLASS A MISDEMttANOR. THE 313TH DISTRICT COURT OF HARRIS COUNTY ENTERED KAREN WITH A SENTENCE OF
2.c.

Fanlily Name NAVARRETE

1.b

Givcn Namc

UDGMENT

ON

rF7

05/25/2004 0N THE CLASS A MISDEMEANOR

1.c.

Middle Name MATA


2.b.

YEAR PROBATION

CO NCING ON 05/25/2004 AND ENDING


2.a.

05/24/2005.

RECORD ATTACHED tJNDER

CRIMINAL RECORD.
2.d. 02/0 /200
TO
0

/02/2003
4.c. Item Number

803 NANCY ROSE


TO /05/2000 2200 FLEMING DR
0

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

9 DEWEY STREET HOUSTON TX 77015


TO

/02/ 996

280 UVALDE RD 305 HOUSTON TX 770 5


03/06/ 995
2000 TO
0

/02/ 996

FLEMING DR 402 HOUSTON TX77013

For USCIS Use Only

FoHll I

821D 08/15/12

Page 6

of 6

Criminal Background Check

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

SOCIAL SECURITY NO:UNAVAlLABLE TO WHOMIT MAY CONCERN:


This certiicatc is issued under scal,ccnitting thatthe information contained herein is a tme and correct
restatement ofthc sull11 ary,electronic data of thc records fllcd and/or rccordcd in the lDistrict Clerk's Offlcc,
as it appears on this date.

The search results are dependent on identiflers entered by the user.


A crilllinal rccol

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

201(:AROLINE P030X4651 H()l ST()N,TEXAS 77210 4651

(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

KAREN NAVARRrE AKA:

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

Atbmey for State: ISSICA CNRD

A" lbr ttSpmdcnll yNCHl%wILLIS Or AdludlC ted on:

Responders Dtte o BItth:9/24/1988


Colmls

-l

POSS CSPG 4 C8G DRL10 Fu ZOW


t*'r', i""r-v,out*
sto$r otT.nsr

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

ld und to b In red SuDervtton d is a m school D18 Ct" : Was

Child formd to hsw englgtd in Dclinquflt Coduct

Cbild in Ncetl of Rchabiliration LJ ls Cuncntly Eurollod st d

Chncs p.*8tion is Re.l,tll(ed

LBst FsnTont

M t 11 l 1 i IPormd mm 0 bOm as r CHld's val


8

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

e hor"andlo tt i posslbl ER ORDERED nJ dlechldbe"mvcd frOlll s/her bo"BIld tt Court wroV


ible For child'sc

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

N8111e orCourt ord


Court Co

v"

"

M tttFttmm

Custouy

Cwmdy c,PO

dhntc8),Cuardl nt3),Or CuStOdicll(Ob "


Due t Inab to Pay ponsible br :I payn

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

cOm ttts Pavee: WArVED


l folio lng personls)Sha

Supevi tt

ltobe F

9 3hal!bc Suri30ry F

:IIanls C unty

Di Ch P.OB 4651,HoustonTx 77210 4651.

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

gh:H County Dtttrlct C!u Ase58Cd 10 bc pald th


deptx Atto ICy Fc shal b

P03

61.Houston I 7 10 4651

d o H COunty

Cencral F

Attorney es P yoe:

Th folttg rSI "


G

shJl be

`N"

2 32 JJ

"ongibh for ttllpayI

P ge I of

-1

'

JUDGUMENr 2m213J p

oRDER
y cque

SJPULA ON TO rHE EVIDENCEior NOLO CONTENDERE: nd BIORE COURIVrruVER OF IIRY l RLtL


Rcsmut10ntO bc Pid ttm H COutt ChlM S
in thc onrount total 8u!} of for &c to RBtinttion Palrcc: in thr anrount for tht total st Jxt ol' !o R6titution P8]4c 2: b thc srmunr
Di sioll

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

Ib folowirg pooon(s) sball

, lL imtal, , rm due by bc rcsPorsible for tull p|yEo

of

to be pad

wrh thiperntduC
br,

by

br tlr lotrl sum of

Thr foltowing pcrsods) shall

rcspmrible fur full

po ncm

Rcstitution Payee 3:

for tlc

thc anDuDl otol sum of

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:

to be pairl through: Tcxas

chilil suPport Disb,uscmctrt unit P.o. Box 659791, Ssn Antoaio.


depoeirc{ into rhc llarris County Goncrol Fuul

T!.xos ?8!65-9791'

Tcrel lrrh,crt Llccuc

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:

R$pon.teDt h ordcred to PrrtlclPrtc


L-l Wcaprxs

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

counsclin mrffilffi"*" Dinc{or

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

**]Iiiiiir* "Ja"y' *li

(b ,"n,in ,utif

am witb my Parcny'gumliat. R7. I wril itrcnd ard particiPstc in

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

BEFORE @URT-WAIVER OF JURY TRI.AL 2q)+{B21AI lrcunqucoclY

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*

"

ic a chitd in necd ofsuPca\dsion (consistcnt u,ith drc affllIllotivo lindiogs abovc)'

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

FURTHER ORDBI{ED rhst tb

[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.

Recomnded ard SIgned on tht the


tloy uf

MAY 2 5

and

Sigrd

on this tbc

313 Dttttt C Ass hte " Tex s Canty

--20.-

Hrrris Counly, Tcxss

Ju rs

RIGHT thunlb"nt

Gr r

WII"

03r3J

Poge 3

of3

1:)

to"r*ru,r,
.,

PCS--&M-.

FEr,oNy ADuoNrsHMENr

15 .

STATE OF TmS COnY OF HARRIS

DISTRECT COURT OF =N THE HARRIS COWrY,TEXAS

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

tbe above waiver of tsrlal by jury and Btlpulation of

HARRISycOUNTY T E X A S

`.

sworn and 3ubSCribed to before me the gAv 6 , day

:P

or

! 200r

strict

CourE

Alxrroved:

lutttAcAis,I)
AY 2 5 2004
riml

APPROVED AND RE MMENDED BY ASttlATE UDGtth ER

Approved Lty the

Court

ict COurt of Harris County, TeXas

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
:

m 312004 Date ofJ

: 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

l Wss Last EDmllcd st in not to hrvc cngged in Delir$rcrt Conduct or to bc a Ctikl

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

ffanil Cornty fwenitc

Probatioo Departnunt is lcEponsiblc for cldld's corc snd


EJ Dcthnrd To Have

Il

Dea<tty Wcapon -

M Alt pryious Rulcs RsDain I! Elfect


Dlrpostdon and Phoemcot:

If nrartcd' dcscribc tlpo ofveapon Probotion Ext rild

Violmd Thc Odccs Of Thc Court

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

Neme of Court Ordercd

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

The following prsor{s) shll

- Duo to Inability to P8y L8Poociblc for full payrcm:

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

firll payrrmt: PcEoD(s) ehall bc rcsponsiblc fot

Comtuutrlg ScrYicr - Numbcr of boun 8trd

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

fbllo pmonc8)3hali be responsible for m p8-t

Rttltutlon to be paid

in the anruot

"usb:II"r

Child Support D

IsloD,H15 Con_Room 10,Housb 77002

of

for dB btsl sum


io RcrtiEtion Paycc:

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

in tbe umutrt for the

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

Thc followiog pcrsonls) shdl bc lrlPofltiblc for ftU po)|trEnt

of

for

tb otrl

srm

of

o bc poll
follo

to R.cstitldo! PayEc 4:

b CSponslble for mo Sh

with initiol pE],Esnt duc by

]p3-t:
n Anmtl

Chlld SuppoH

' 7 1

s7 "

m suppOrt Payec E 1lo pLTonls)nall bc,sponsLk for fu pa


T 38
Drlver3 LIcew Restrictions:

No Driver Liccase Rcsuictior


Section 54.04 (i) of the Texas Frmily Codc.

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

-'-1 Drug FnxYouth

U mC

Ortcrtr

i-

cED

r,ogrsnr

Wo*shop

fl

lndividsEl

Counsrlin L] eng.1 Vanrgcrmnt Cormdin E ll xr ontnac' cormectin

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

No C.ontrct - Goag Menrbers

Ruler of

kobrtlon: Rl. I wiU rcport b my lwcrilc


within thce days.

Prcbstion Otrlccr. us rquGtcd, and

wil Ilpori

0try

cblogr of addnr$' school or cEPlq|Dcnt

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

witb ruy pueut/guordian.

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

R9. I wilt ,?ort to my MuDicipsl Co,rt

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

REMEMBERED rbat ttis csur beiog caltcd for


causo

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.

IT Ili FI,JRTIIR. ORDERBD, the6aid child


indicat d ebow, vibo wiII

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,

q$sidr hit&crhome for

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

RTHER SRDERED hat

tb

HEni! courty Juvcuilc Protarion

Deprrbr

bc responsiblc for child's ploccrEot c'tu,


56'01

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

proctdrnts br sea.lirg rcmrds in Scclion 5E'003 of thc Tcxrs Familv Codc'

Rcconuncodcd and Siglcd otr

tis

ths

AUO

3 I m(tf

A 8i

and Signed on histbe

",313 th DIs

Ict COm

JudgO,313 th DLrict C"rt

COutt Tem3


" "=

::
L_ _ ___

Juven RIGHr thunlb prlnt

"

321JJ

Prgc 3

of3

'

0.2004-032 3

OF SE(S)3

ELGT

STATE OF COUNTY OF HARRIS

REOp N THE 3 3 H DISTRICT COURT OF

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

= PR TER3 DAYS. mTE

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

the above rraiver of trial blr jury and stipulatlon of evldence.


. IIRRIS CONY T E X A S

s
a013,PIlr3 1

o,o

thll

ll

:11

ll

li

1 ,

::
` i

.11

Identity Documents

= = = =

-2-

Fl

ESTADOS UNIDOS MEXiCANOS


PSEPORI
PASSXl 1

: r lT

mttA TE
ATA
A [

trffbadl&

.{$

,.sd

21 SEP

" 1'33

tt


HousTo

e,an 25 J
=

EXNAVARRETE ATA KAREN <


< 2

8484144630 EX8809210F1302251

Birth Certificate

TRANSLAT:ON OF''B!RTH CERT:FICATE''

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

PD EL:A MARTINEZ LEON


01 Book 32 Year 1988

CERTIF:CATE FOUND:Civil Registry,Office


Mexico

Act 06195 Locanty TlatnepanJa

Registry Date l1/30/1988

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.

l, Bernardo Eureste, hereby

Date

December 28. 2012

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

DEL RECISTRO CIVI ,DOY FE

=
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

Applying as "High Schoo! Diploma"


&

Evidence Supporting Claim that Applicant for Deferred Action


Arrived:n the United States since on or before June 15,

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

HIGH SCHOOL DIPLOMA

MiSCELANEOUS DOCUMENttS
From
05/28/1997 o
12/16/12

RQ6L022A S:

FS:0377178378

II11 111 III


I

Celltral File Mailltcnallce

P O BOX 12048 AUSTIN,lX 78711-2048

5-DIGI ==== AU 0 44807 1 AV 0 350

77015

OFFICE OF THE ATTORNEY GENERAL STATE OF TE)(AS CHILD SUPPORT DIVISION

550 NORMANDY S 25 2 HOUS ON TX 77015-3439


1:lllllllllll:11:llll:::ll:11:::::]:::::::l:::::lllilllillll

KAREN NA ARREttE

Gnnc Annorr
Attorney General

Date: Decembr 16,2012

Si necesita asistencia para leer esta carta, por favor llame al nfnrero: (800)252-8014

REPORT OF SUPPORT COLLECTED IN NOVE lBER,2012.


Tllis is a report oftlle support wc collected alld pr

essed for your child(rell)dllring ule mondl of NO E :I EIt

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

$5769 $5769 $962


S()0()

$()0()

JONES JO S JONES JONES

0012301907 0012301907 0012301907


00123019()7

201067934 201067934 201067934 201067934

]1/13/12 11/13/12
11/26/12
11/2('/12

11/13/12

S5769 S5769 $5769 S5769

l1/13/12 11/26/12 11/26/12

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

IF PAYING BY CREDIT CARD, FILL OUT BELOW

.1 1
. k

] P lARttN l l A[

LMHCl
Please detach and return bottom portion with your payment

REMiT TO:
965009691092
:1

UNT$

HARRIS HEALTH SYSttEM P O BOX 203736 HOUS ON,TX 77216-3736

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

Number of checks enclosed:0

::::::ll::::lll:::ll::llllll::llllllll::!:!

2/18 0,1 02 MD

3 2 8

264 020476 #00 AV O.350

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.

Your Stqtement SummorY


t

Checking Regrilar Savings

586009882620 586009877745

12

07

12-07

2.70 14.31

TOtal Deposit AccO_t Balance$17.01


Banking products such as cheCkl g and savinF accountS are OFFered by Bank of America,N.A.i lnember FDIC.Bank of AInerica credt Cards
are is"ued and adlnini tered by FIA Card Services,N.A.

Totalamount due

$
8812

AnnBTTENERGY
Account A2995064
invoice 244D9 5

Amount due r pald after due date $

b SSR:

ri : $
Amount enclosed $

tfditfsstrrm
'Total amomt due"

Karen Navarrete ,

Please make payment to:

Ambit Energy
P.O. Box 66O462 Dallas, TX 752ffi-M62

550 Normandy St Apt 2512

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

Hours of Operatlon:Mon Fn,8 AM to 6 PM and Sat10 AM to 5 PM CT To report a power outage or emergency,


pleas ca

Your Consultant: lGren Navanete

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

697 014 397 8453

Total Amount Due Past balance due now

Account Details
Houston, TX 77015

ES D:l

ofl

3439


ND FMAMJJASON

Current Plan: Lone Star Select -

12 Month Term Plan

Terln End Date:05/13/13

Current Charges
Ambit Energy Charges
Customer Charge
.

Energy Charge (29 days, 678 kVVh @ $0.0936)

6346 999

Total Ambit Energy Charges

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

(Street address and dwelling unit number, if applicable)

Eouston. llX
,State,zipD

TAAbaseCoubactdated As on contract
between residssts named abov5 atrd

Vil1a Sierra' Iff


(0
Dear Resident(s): Becatrse youhavenotpaid

rc$E

allocatedorsubmeteredrdilities,

a utility bilt for rvhich you are re,sponsible or Eothcr

of your lease. You

are

still {iable for reut

,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

Demand for possession

Peace. Delay or postpoaement of suct artiou does Dot waivo

o*

.ightr.

Ihis notice to vacate is unconditioual; howwer, if


dwelliag, please contact
2/7/ 2
us.

you wish to discuss possible reinstatement of your right to continue tiving

in

the

1
the method checked below

DATE aotice was given by

Thenotice

was: (checkat

lAtt

one)

residents namcd above; , hand delivered to any person 16 or older residing iu the dwelliug;

handdeliveredtoanyoneofthe
'

E posted on the main enw


tat has a key

of the dw , .trot the screen door) bolting device or


on it;

sent by sent by

first class mail; certified mait

keyld

retum receipt roquested; or sent by regiserod mail.

lr

AnnerrrNERGY
Account:A2995064 :nvoice:244D9
5

Total amount

due

Amount enclosed $
Karen Navarrete 550 Normandy St Apt 25'12 Houston, fX77015

Plee

make

patmfft to: Arntit

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,

Account Number: lnvoice Number: Billing Date:


Past Due:

Amt. Required to Avoid Disconnect: Due Date: Disconnect Date:

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

Customer Name:Karen Navarete Account Number A2995064


invoice Number:244D9 5 28,2'6244

Gustomer Carez

(84

Hours of Operation: Mon - Fri, B AM to

6PMandSat

IOAMto5PMCT

Centerpoint TDU Delivery Charges

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

Total Centerpoint TDU Delivery


Taxes and other fees
Energy Taxes and other fees

Charges

$ $

$
$ $

013
001 0.14

TDU Taxes and otherfees Total Taxes and otherfees

Total Current Charges

Miscellaneous Adiustments
Current Miscellaneous Adjustments
Late Pavment

Penaltv

Total Current Miscellaneous

Adiustments

$ $
$

3.97
S.SZ

Prior Period Miscellaneous Adjustments


PCRF Refund

(11301

Credt Card Transaction Fee

$
$

250
{8.801

Totai PHor period Miscellaneous Attustments

Page 3 of 3

u i

1/1/2012 1/1/2012
1 1

Rent(01/201

2012 2012 2012

Sewer(01/2012) Water(01/2012)
Trash(01/2012)

1/1/2012
1/1

71300 1350 675 500


276

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)

2/1/2012 2/1/2012 2/1/2012


2/1 2012

water(p

2012)

Trash(02/2012)
Bil ng Fees(02 2012)

2/1/2012 2/6/2012 2/8/2012


2/9 2012

Late Fees Late Fees Rent is $723.00 Per lease renewal

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

34472321 344 2549 34472776 34472999 34524261


22809664

3/1/2012 3/1/2012 3/1/2012


3/1

1,65718 1,66713 1,68702

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

50000 36702 2500


11000 72300 2000 776 1000

84702 75702 78202 28202


(8500) (11000)

3/26/2012
4/1 2012

Paid rent lLte

Rent(04/ 017) Relmbttrped Sewer

4/1/2012 4/1/2012 4/1/2012 4/3/2012 4/19/2012 5/1/2012


5/1
5

burled trash Reimbursed water

000 72300 74300 75076 76076 72300 3750


6 3

chk#14490565945 chk,14490566234
Rent(05/2012)
Reimbursed Sewer Re mbursed Trash Reimbursed Water

2012 2012

1/2012 3/2012

5/1
5

72300 2000 776 1000


72300 2300 2000 776 1000 73000 3900

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

72300 2000 776

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

38171149 38289456 38289457

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

850.54 860.00 860.00 0.00 723.00 743.00 750.76 763.06 765.00


(1.94)

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

25.82 35.82 758.82 300.00 458.82 598.82

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

550 Normandy Street


Houston, X77015

Billing Date:
Unit: Account #: Move in Date: Balance Forward:

11/26/2012 unit 2512


RIV VSA2012042512

ELECTRONIC SERViCE REQUESTED

02/12/2011

S16262

Tota:Due:
(!f pald by 12/01/2012)

s925.04 check#:

Amount Paid:

Make Payments Payable To:

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

Fo proper()redit,please detaCh and retu

n t19 upper

po ion with your paymeni tthank you

Property Fees
$723.00

RESiDENT ACCOUNT STATEMENT


Utility Fees
$39.42

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

550 Normandy Street


Houston, X 77015

Property Fees:
Rent

91s: Water Base A ocation(09/24-10/28)

iIli111lli[]llililll:`11
RUBS:l Unl X l1 65922619

'MESSAGE BOARD ,T:


el1 66

Water Conservation Tip:


Ve money on yow

y bo Sa ng

Water Exp occupant A ocatbn(09/24-10/28)

$000 $2000 $000 $500 $276 S3942


$925.04

nd, rc _worker b a Slerra and recdve$300 c


a7

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

Trash Admin Fee(09/2410/28)


F!at Charge
Ut ity

Charges and Property charges Due

TOTAL DUE:f paid by 12r01 2012:


i,

* 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

Total Taxes, Surcharges & Fees

and$hargel
Digital'Adapter Service

000
11/24-12/23
$61.49

Adapter Service
additiona1 0utlet

otal

XFINITY TV

Late Charge State Cost Recovery Charge

.The State Cost Recovery Charge is imposed by Comcast on its


Texas subscribers to recover a portion of its expenses associated with charges imposed on Comoast by the State of to collect this cost.

T"rygry"t ilq tryy,*llfly


Tota! Other Charges & Gredits

$8.49

State Franchise

Fee

077
461

State and Local Sales Tax

1 il i:
FS1 0375346626
Ccntral File Mailltellancc

R, L022A

SI

P o BOX 12048 AUSTIN,TX 78711-2048

+ AUTO =

5-DIGIT 7701 5
'

OFFICE OF THE ATTORNEY GENERAL STATE OF TE){AS CHILD SUPPORT DIVISION

48146 1 AV 0 350

HOUS ON,TX 7 015-3439


11:]::::: :::lll

ia
4
lll:::l:ll::::i:llll`::113::ll!ll::: ::l

GnBc

Assorr

AttorlleY Getleral

Date: November 18, 2012

Si necesita asistettcia para lecr esta carta' per- ft :t<lr* l! nr::e o! n{rnrcro: (:it}l})2i2-{}{l 1'{

REPORT OF SUPPORT COLLECTED IN OCTOBER,2012.


rell)during ulc nl 111l of O(II OI ltR 1 is is a report oFdle support C011ectcd alld processcd for your chil

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:

201067'34 201067934 201067934

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

October 17,2012 th ugh November16,2012

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

Step 2 Add Step 2 otaito Step l Ba:ance.


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

Check Number or Date

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

JPMorgan Chase Bank,N.A.Melnber FDiC

Page 3 ol 4

PO.Box 203735,Houston:TX d 77216-3735


Outstanding Balance Pending lnsurance Payment: Current Patient Balance Due on or before 1210712012
:Accounti035001771934

GUARANTOR NUMBER:100406287 PAGE NUMBER:2/2

: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:

Transferred to Patient Responsib

$142.00

Palent Payment and Adiustments:


02 27

-$10400
$33.00 $71.00
$0.00 $38.00

2012 CASH

03/04 2012

Adiustment

2 :l :t ::] :I l

Har s COunty Hosplal DlstHCt

PO.Box 203735
HoustOn,TX 77216-3735 (713)566-6600

$24715


Page Number 1/2
15L
::::

JL lil=1

I: :0

4U:ZI

Harns cOunty Hosplal DistHctis now Harris Health System

100406287

P.O Box 203735 Houston,TX 77216-3735


Physician services may be b led separately.
For questlons related to Unlversity of ttexas, please ca 713-500-3500.
:::

I
llllllill:l=`::llllli::::

i::l:llllll :::lllllll::ll::

For questions related to Baylor Col!ege of Medicine


please ca 713 798-1900.


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:

Harris Health System

peer KARFN NAVARRETEI


:

1
ltatement eas9"
71 566-6ooO.
IS at

$1,047.00

Charge Summary: CLINIC

` `

LABORATORY PHARMACY PREVENTIVE CARE SERViCES


Payment Total:
Adiustment ttotal:

$104.00 $862.00 $67.00 $14.00


$0.00 $0.00 $0.00

lnsurance Payments and Adiustments:

ransferred to Patient Responsib


OinCerelyl Ho IS

ity:

$1,047.00 $38.00 $837.85

Oystem HII

Pa ent Payment and Adiustments:

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

Please return bottom portion with your payment V

By PhOne at(713)566-6600 D By Mall atthe remk address below


CHECKCARD USING FOh PAYMENT
3vV2 AMOUNT PA:D EXP DATE

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

t PO.Box 203735,Houston:TX 77216-3735

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

enter your donation and check the

box. $

ffdilfermtfrm
Total amomt dre'

Amount enclosed $
Karen Navarrete
DO NOT PAY

550 Normandy St Apt 2512


701,P Houston,

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

Keep this part for your records.

AnnBtr

EN ERG Y

+
l

Statement Date: 1Ol2U12


Customer name: Karen Navarrete Valued customer since: 11/OU11 Account number: A299564 lnvoice number: 2O7 A1 J7

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

6 PM and Sat10 AMto 5 PM CT

Your Consultant: lGren Navanete

& 1

Account Summary
' ' I
Previous balance

For rnore information

10575

about residential electric

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

7214 1143 529 9602

messages

Tota! Amount Due Past balance due now

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

Current Plan: Lone Star Select - 12 Month Term Plan'

erm End Date:05/13/13

ONDJFMAMJJASO

Gurrent Gharges
Ambit Energy Charges
Energy Charge (29 days, 664

about calculation

',1

kwh

$0.0936)

6215

Total Ambit Energy Charges

Page 1 of 3

Statement Datel 10/22/12


PUC License:

Due Date:11/07/12

10.1

17

Customer Name:Karen Navarete Account Number A2995064


invoice Number:207Al 7

Customer Gare: (874 28,2-6248


Hours of Operation: Mon - Fri, B AM to

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

Centerpoint TDU Delivery Charges


Delivery Rate lncrease 9/1A-1O/17

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

Total Genterpoint TDU Delivery Charges


Taxes and other fees
Energy Taxes and other fees TDU Taxes and other fees

7.16

.PowerCostRecoveryFactorS/1

-8/31

014

001
tl.za

Total Taxes and other fees

11.43

Total Current Charges

90.73

pm.CT

iscellaneous Adiustments
529
5.29

Current Miscellaneous Adjustments


Late Payment Penalty

Total Current Miscellaneous Adiustments

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

Contact Te!# 2-11


o fo

out of state ca ers,

ca

1-877-541-7905

98' oo

9602S300 W STE A
Sandy UT 34070 3301

Comcasl

Date1 0ctober 31,2012 Account F1 8777701260367 62 Past Oue Batance:ss4 44

RET RN

SERViCE REOuESTED

Total Balance:912163

!:.,1,1!1,ll,1.l..: ,,,!!l.1.ll[.lIl11.11!:11..:[111'

:
,

KAREN NAVARRETE

550 NORMANDY ST APT 2512 HOuSTON TX 77015 3430

@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

ACTION REQUIRED TO AVOID DISCONNECTION OF SERVICE

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

lmportantl Mailed payment may teke up to P ase


.

to your

account.

Detach Lower Ponio 3hd Return w"h Payment

9872,TH2PRFS0 273

KAREN NAVARRETE
550 NORMANDY ST APT 25,2 HOuSTON TX 77015 3439

Date OctOber 31 2012

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

or olher major crediUdebit card

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

OFFICE OF THE AITORNEY GENERAL STATE OF TEXAS CHILD SUPPORT DIVISION

33881 l AV 0 350

KAREN NAVARRETE ' 550 NORMANDY S 2512 HOUS ON X77015-3439


:lllll::::llllllll:l1111:illl1ll:l::11:::llllill:l llllli:ll::1:l

Gnsc Annorr
Attorney General

Date: October 21,2012

Si necesita asistencia para leer esta carta, por favor llame al nfmero: (800)252-8014

REPORT OF SIIPPORT COLLECTED IN SEPTEMBER,2012.


This is a report ofthe support ve collected and pr essed for your child(ren)durlng the inonth of sEPTE

IBER

how nllich ofthc total was scnt to your fanlily

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.

P,O Box 203735

Houston, X77216-3735

Page Numbe
15

l:ll:lillil::l:::lllllllllllll::

:lll:lillllllllililil::llllll

KAREN NAVARRETE 550 NORMANDY ST APT 2512 HoUSTONlTX 77015 3439

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.

Please return bottom portion with your payment V'

By PhOne at(713)566-6600 D By Mailatthe reml address below

CHECK CARD USING FOR PAYMENT


3ARD NUMBER
SiGNATURE
IAMOuN
C 2


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

P.0.BOX 203735,Houston,TX 77216-3735

7 LI L L 7 5 L 7L L

AnnBITENERGY
Account:A2995064

Total amount due Amount enclosed


96.02

invoice:207Al 7

Karen Navarrete l

550 Normandy St Apt 2512

7ALJ7

Please make payment to: Ambtt Energy P O Box 660462


Dallas,TX 75266-0462

5 L LI
i
I

.\-

Please mail this portion with your payment. Make check payable to: Ambit Energy,

Keep this pan lor your

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

Account Number: lnvoice Number: Billing Date:


Past Due: Amt. Required to Avoid Disconnect: Due Date: Disconnect Date:

A2995064
207Al 7

10/22/2012 $96.02 $96.02 11/19/2012 11/20/2012

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

du= tOmc com

00XttMTY

Karen Navarrete
For servico

al:

sso NoRMANDY ST APT 25121


HOUSTON

Previous Balance Credit Card Payment - 10103112


'i
,,

10029 -4588

TX77o15-3439 r, l'.'

Unpaid Balance - Due Now New Charges - Due by 11108112


I

6712
$121.53

54.41

See below for more information

News from Comcast


Unpaid balance due immediately. A late fee of $8.00 will apply to past due accounls. Once disconnected, an activation fee up to $34.95 mayiapplr. Restarting service that requires a technician visit will have a prepayment of a deposit, restart fee, and first month's payment. There is a charge for all unreturned equipment.
Comcast SportsNet Houston is now available on XFINTY TV Digital Starter service, on channel 39 or 639 in HD. This network offers exclusive regional coverage of the Astros and Rockets, extensive pre and post-game coverage, team and player pecific programming, and major collegiate and high school programming.
Save time. Save a tree. Your entire statement is available online. Sign up today for secure online billing and say goodbye to your paper bill for-

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

Account Number Payment Due By TotalAmount Due Amount Enclosed

8777701260367062 Due Now


$121.53

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

P O BOX 14900 M:DLAND TX 79711 4900

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

We wiil cali betweeni 10:00 AM and 10:30 AM


Phone numberlwe will use to ca you:(832)748 3874
1 !

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

Follow-up and Disposition


Level of Service

Navarrete,Karen(MR#037849472)Printed at 1 0 17/12 11:45 AM

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

WET MOUNT PAP SMEAR


KOH STAIN
l

CHLAM GC DNA AMPLi

MediCation Reconciliatio
Refills
O.1 I

tablet

desogestrel-eth inyl

Prescription i

s e-Prescribed

eCtrpqiot (VE LIV ET)


,

r
'

'l

.125 l -15-25 m g-mcg

3/3

Sig - Floute: Take 1 teblet by mouth daily. - Oral

Class: ePrescribe Phannacy: STRAWBEBHY HEALTH CNTR PHARMACY (Ph #: 713-982-5182)


Current Medications
desogestre ethlny:estradioi(VEL:VET)
0 1

Dosage
Take l tablet by rnouth da
y.

,12541012, g: 99 1011et

desogestre ethinyl estradio:(VEL:VET)


0 1

ake l tablet by rnouth daily.

12 ,10 21 g 99 1ollet BENZOYL PEROX:DE 2.5 /.Gei

METRONIDAZOLE 500 MG TAB


Review info

:: I %T
:

USer ENN!FER 0 0KOH,MD IP0361101

Date and Time

10/17/201211:31 AM

: : ll ::i:lpr X:
12/4/201212:00PM IT8P91

structlons l l Patient lnstructions p Va. S:ly

BRAASTAD,WILttAM DENttST

1
:

::TRAWBERRY I

Your Primary Care Physician is Jennifer O Okoh, MD, MD

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

Navarrete, Karen (MR 11:45 AM

# 037849472) Printed al1Ol17t12

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

Provlder ennifer 0 0koh,

Depanment
St Family Practice

Dept Phone
713 982-5900

MD

After Visn Summa

Karen Navarrete (MRN 037849472)

ViSitlnhmmn 0

Vistt and

Patient lnformation
Depanment
St Family Practice

Provider Jennifer 0 0koh,

Encounter# 58657452

MD

Patient lnformation Patient Name Sex Navarrete,I Female Karen (037849472)

Patient

Demographics

Address 550 Normandy.

Phone
832 748.3874(HOme)

Address navarrete-karen
E ma

yahoo.com

Apt-2512 HOUS ON TX 77015

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

VisI Diag oses am wnh routtne gynecologicai exam

Screening for HiV(human inl:nunodeficiency virus) Oral ontraceptive use

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

GLUCOSE, FASTING LIPID PROFILE


Navarrete, Karen (MR # 097849472) Printed a|10117112 11:45 AM

HA5E
PMorgan

October 17,2012 through November 16,2012

Chase Bank,NA

P O Box 659754 San Antonio,TX 78265-9754

Account Number

000000994261782

CUSTOMER SERViCEINFORMAT10N
00095765 1 AV O.35
111 11
ll
l

1111

1ll

1:l

lllllllllll

1:ll

1lllllll

lll!
1

oooesT6s DRE 2o1 140 32212 yNNNyNNyNNN

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

Chase College Checking $0.00

45751
30309

ATM&Deb Card WIhdrawals


Ending Ba:ance

$154.42

DEPOS:TS AND ADDiT:ONS


DATE
10/19 11/05 11/06 11/13 11/15 11/16
DESCRIPTTON

AMOUNT 422406132 428316618


383236653
`

Deposit Deposit Deposit Deposit

408286163
4082861,99

$12000 4500 2000 8251 12900 6100


$457.51

Tota:Deposits and Additions

Page 1 ol 4


Ha s

County Hosplal Distnctis nOw

Harris Health System

____i LL_ L___ [


PAY THiS

P.O Box 203735 Houston,TX 77216-3735


Page Numbe

-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

KAREN NA ARRETEI 550 NORMANDY Stt APT 2512 HOUSTON, X77015-3439

For questions related to Baylor College of Medicine, please call 71 3-798-1 900.

MESSAGES
Harris County Hospital District is now

DESCR:PT10N

Harris Health System


DeaT 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.

Tota!Charges Billed:

S14200
$142.00
$0.00

charge Summary: CLINIC

LABORATORY

lnsurance Payments and Adiustments:


Payment ttotal: Adiustment ttota!: Transferred to Palent Responsibility:
Pa ent 02/27

$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

Payment and Adiustmentsi

03 04/2012

Adiustment

-$7100

EI Please check box if above address is lncorrect

V Please return bottom portion with your payment V

and indlcate change(s)On reverse side

You may pay your bill

By PhOne at{713)566 6600

gD By Mallatthe remk address below


3ARD NUMBER
SIGNATURE

CHECK CARD USING FORIPAYMENT


C


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

P O Box 203735,Houston,TX 77216-3735

7 11 LI L L 1 L 7L L

Comcasl 9602S300 VV
Sandy UT 34070

Datei Seplember 30.2012

Accouni#:8777701260367 62 Past Due Balance:S4588 Total Balance:110029

RETURN SERV10E REOUESTED

l![1:.1:[.[[lill....,,,,111.!.lllll,:[.:,.!.111111.11.l.

KAREN NAVARRETE

550 NORMANDY ST APT 2512 HOuSTON TX 77015 3439

@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

ACTION IREQUIRED TO AVOID DISCONNECTION OF SERVICE

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

You can lnd a,Comcag Sloes doseu lo you 4

D ! :, lW % ? Pttr )
:1
S ncere

Comcast Cab e Communicalons

Fau b ule one d he paymem Oplons a ve may ttsm m se e utton or ?

1mportant: Ma ed payment may take up t0 7 days to arive and pOstt our account P h12

"LLttd Retur,with Payment

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

lJse this coupOn to mall youi check or

money o de You may also ca"us tO

0018
11

free at l 300

COMCAST (1-800

266

2273)to make a payment wlh yOu visa


,t,ll11,1111111,

11,,,l,I,l,,i:,l,11,,1:l,,11,,,,11,t,,

or olher malo credil debl card

@omcost
87777 lPL 70L20 Oa 7

An BITENERGY
Account:A2995064 invoice:163ElD8

Total amount due

10575

Amount enclosed
Karen Navarrete

550 Normandy St Apt 2512

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.

Keep this part for your records.

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

5s0 NoRMANDY ST APT 2q12; HOUSTON TX77015-3439


I

Unpaid Balance - Due Now New Charges - Due by 1OlO9l12


See below for more information

5441 $100129

News from Comcast


unpald balance due immedietely A late fee of$800 will apply lo past due accounts Once disconnected,an
activatlon fee up to S34 95 may apply Restarting
service that requlres a techn:cian visit will have a

TotalAmount Due

MTY

TV

3999 835 607


$5441

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

Visit w comcast com support to register today


More information regarding our rates is
ava able

on our webslte comcast com

6489)

or you can ca us at l-800-XFINI Y(1-800-934-

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

Account Number Payment Due By Total Amount Due Amount Enclosed

8777701260367062 Due Now


$100.29

550 NORMANDY ST APT 2512 HOUSTON:TX 77015-3439

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

$5441 -Due 10/09/12

$10029
Page 3 of4

COMCAST PRiCEINFORMAT:ON
Houston,TX
Dear Valued Customer;
l .II

August,2012

BAS:C AND D:GITAL ANCiLLARY SERV:CES(per mOnth)


Current MbltiLatho.

$1295
. .
.

Price

New Price

$1495
S 1795
$ 1 99 ea

HD/DVR Service.... , .

. . $ 1695

More to Watch,More Ways Anytime,Anywherel on Any screen

Digita:Adapter Addl10na1 0u et Service

xRHtty@ 0n Demand gives you the most free choices-thousands of top


shows and hit movies-and 90% are free.
Watch from your TV or online, anytime, anywhere-even from your Apple or Android tablet or smartphone with the XFINITY TV apps. Catch up and keep up with your favorite shows from all top networks & enjoy new movies-many a month before Netflix and Redbox.

Not

(lSt and 2nd add ond oulotsl .. ..


avanable fOr Bas:o only subscribers

. .

.3 000

DiG:TAL SERViCES(per mOnth)


Current
` 019ital Preferred . D19ital Stalter.

Digital Preferred Digital Premier

Fastest lnternet Speeds + Most Comprehensive Security = The Best 0nline Experience

$5799 , . . . . ,$7599 Plus . $9799 Sll1 99 , .

Price New Price $61,49

37949

3102.99
Sl16 99

o . .
*

ViDEO EQUIPMENT(per mOnth)


Current Remote Control,

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

XF TR:PLE PLAY PACKAGES


MULT:LAT:NO PAQUEttE TR:PLE PACKAGES(per mOnth)
Current
Starter XF Trlple Play Bundle.

Price

New Price

According to a recent FCC repoft entitled,zllz Measuring Broadband Aneica,


issued Juty,

2012

Comcast Customer Guarantee and Coinmilment to Service

'

. .,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.

TR:PLE PLAY PACKAGES(per mOnth)


Current
Economy Tr 10 Phy.

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.

XF: :Y: TERNET(per

CurrentPrice New.Price
Performance Wth XFINITY TV or Voice Service
8hst!

$ 4895 Wtt XttMTY TV or Vote Seruce. $5895

$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

BAS:C SERViCES(per mOnth)


I Current Price New Price

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.

1360,1380-1540, 1010,1020,1060-1080,1100-112011140-1190,1210 1500-1620,2000 209013000-3120,3150 3210,5020,50311,5100-5160

SA7CF06U

HA5
PMorgan

August 16,2012 thrOugh September 18.2012

Chase Bank,NA

P O Bop1 659754 San Anlonio,TX 78265 9754

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

00036577 DRE 201 140 26312 NNNNNNNNNYN T l

ll:=::::1lll!`=:ll==!:11:llill:::1:==:::!!!:ll X

DeaF and Hard ol Hearng: si

1-800-242-7383

KAREN MATA NAVARRETE

'110000T711994P16005

1-877-312-4273
l-713-262-1679

550 NORMANDY ST APT 2512 HOUSTON TX 77015-3


9

CHECKING SUMMARY ChaseCdbgeCheckhg___


Beginning Balance
Deposls and AddllonS

T_
S178

19700
7616

ATM&Debl Card VVnhdrawals


Ending Balance

Sl19 06

DESCRIPT10N

AMOuNT

o9/1l
09/18

Depos1
Depos1

402012,77-_
396402776 __

$5700 V 14000 VV S19700

Total Deposils and Additlons

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

s1015 1062 2000 406 615


1 30

Card Purchase Card Purchase

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

Card Pu chase Wnh Pin o9/13

0918

Card Purchaso Wlh Pin 09/18 Wa Mart StOre HoustOn TX Card 1913

130 164 2094 $7616

Tolal ATM & Debit Card Withdrawals

MC:E

RQ6L022A Sl

I : I
FSi 0370944227
Ccntral File raintcnance

P O BOX 12048

AUSTIN,TX 787H-2048

OFFICE OF THE ATTORNEY GENERAL STATE OF TEXAS


= =AUTO 44975 1 AV 0 350

5-DiGIT 7701 5

CHiLD SUPPoRtt DiV:S:ON

KAREN NA ARRETE 550 NORMANDY S 2512 HOUSTON X77015-3439


11illil:l
::

GREG ABBoTT
Attorney General

l::

:]111111:lilll`3`lli:::ll:11: ::::

:31ililil

Datei Scptcinber 16,2012

Si necesita asistencia para leer esta carta, por favor llame al numero: (800)252-8014

REPORT OF SUPPORT COLLECTED IN AUGUST,2012.


nis is a rcpOrt ofthe support we collcctcd alld processcd for your child(rell)dllrulg

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.

lf the patient is deceased;

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

Health lnformation Management Release of lnformation

1 1

,l**lt,rlarrlS (lrurlll W Hospital Disfrct


Harris County Hospital District is now Harris Health SYstem P.O. Box 203735 Houston, TX 77216-3735 Page Number: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

Charge Summary: CLINIC

LABORATORY

lnsurance Payments and Adiustments:


Payment ttotal: Adiustment Total:

$0.00 $0.00 $0.00

Office hours: M-F 8:00 a.m. - 4:30 P'm'


lf you have any questions after officq hours, you can e-mail us at

customerservice@harrishealth.ord,

ransferred to Pa ent Responsibility:


.

$142.00
-$104.00

Financial assistance may be avqi[1ble. Call us today to learn ', i

more. '

Pa ent Payment and Adiustments:


02

27/2012 CASH

$33.00

Sincerely,
L

03/04/2012 Adiustment

-$71.00

Please check boX if above address is incorrect

V Please return bottom portion with your payment V

and indicate change(s)On reverse side.


You may pay your blll

By PhOne at{713)566 6600

gD By Mallatthe reml address below

CHECK CARD US:NG FOR PAYMENT

CARD NUMBER
SIGNATURE
ltl=INewi AMO

MOUNT PAID CW2


EXP DATE

Make checks, money orders payable and mail payments to: Harris Health SYstem

GUARANTOR NUMBER

STATEMENT DATE

$38.00

100406287

09/11/2012

t PO.Box 203735:Houston,TX 77216-3735

7 L LL L 87L L

AnnBITENERG Y
Account A2995064

Total amount

due
date

$
$

148.27

Amount due if paid after due

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

550 Normandy St Apt.2512

701, Houdon,
1

/ Lb

P O Box 660462 Da as,TX 75266-0462

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

Statement Date: OBl22l 12

AnnBtTENERGY
PUC Ucense: 10117

Customer name: Karen Navarrete Valued customer since: 11/08/11 Account number: A2995064 lnvoice number: I1641A2

Customer Care: (877) 282-6248


Hours of Operation: Mon - Fri, 8 AM to

6PMandSat 10AMto5PMCT
To report a power outage or emergency, please cdl Cer rierpoirrt at (8O0) 3J2- r t43

Your Consultant: Karen Navanete

Account Summary
I

For more information about residential electric service, please visit I


www. powe rto c ho o se. co ql
lmportant

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.

$ $ $ $

$
$

17464 760 027

514

18765
148.27

Total Amount Due Past balance due now

45.73

Account Details
Houston, TX 77015 3439

ES D:l

ofl

ESID

Current Plan: Lone Star Select - 12 Month Term Plan


ASONDJFMAMJJA
The avbrage price you paid for electric service this month is $0.113 per kwh. Sqe page 2 for more in,ormation about I average price calculation

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

Bank of Anerica P.0. BOX 3550 Rancho COrdova, CA 95741 3530

Request For Dupllcato Statement(s) Date of Notice: SEPTE14BER 12, 2012

2040
::

006

8P

.424

Account Number: 586007,4982`

_Tl11

::::li,I :

HouSTON TX 77015

111

Reference Number: 201209120002,0

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

Last Statement Date: 09/10/09


STATEMENTS AU003 SEP081 11C108 NOV08 DEC08
AN09

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

PUC License:10117 Customer Care:(8771282 6248


Hours of Operation:Mon

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)

Hurr lke Restoration Chg

Hurrlcane lke ADFIT Credl


Total Centerpoint TDU Delivery Charges Taxes and other fees
Energy Taxes and other fees TDU Taxes and other fees

$
$

7.60

001
182.51

026

Total Taxes and other fees

0.27

Total Current Charges

iscellaneous Adiustments
514
5.14

Current Miscellaneous Adiustments


Late Pavment Penalty

Total Current Miscellaneous Adiustments

Prior Period Miscellaneous Adiustments


.ll ,'1 1

Credit Card Transaction

Fee

Totat Prior Period Miscellaneous

$ _ Adiustments $

2.5o 2-50

Pa99 3 of3

AnnBlr
Account:A2995064

EN ERGY
invoice: 116AlA2

Total amount due Amount enclosed

10254

Karen Navarrete 550 Normandy St Apt 2512 Houston, TX77015

Please make payment to: Ambit Energy


P.O. Box 660462
Dallas, TX 75266-0462

5 L

LI

LLLALA

L 5

iS Please ma

ponloilwlhy u,pa llent Make check payable to:Ainbit Energy

Keep this pan fOl yotJ recortls

An BITENERGY
September 10,2012
Dear Karen,

Account Number: lnvoice Number:


Billing Date: Past Due: Amt. Required to Avoid Disconnect: Due Date: Disconnect Date:

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

AUSIIN,TX 787H 048

OFFICE OF THE ATTORNEY GENERAL STATE OF TEXAS


'AUTO ==
5

DIGIT 77015

CHILD SuPPORT DlViS10N

45365,AV 0 050

KAREN NAVARRETE 550 NORMANDY ST 2512 HOuSTON TX 77015-3439


1:11::::l:lll::::!::ll!ll::lllllll:111::lll:llll:::!::llll::

GREG AB30TT
Atlor:ley ccllcral

Da(e: August 18,2012

Si lleccsita nsistcilcia par

lecr cst:t carta,

por Favor llanlc al n`mcru:0('( 252-8014

REPORT OFSUPPORT COLLECTED IN JULY,2012.


This is a report of tlle support

COllCCtcd alld pr cssed for youl child(rcll)du llg

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

$5769 $5769 $5769

$5769 $5769 s962

$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

Heaith Behavior Research and Training lnstitute

ll

THE UNIVERSll Y OF TEXAS AT AUS IN


S

6 Street. 1717
F

r512,232-0638

aS 8703 r512,232-06340 St 295 h/CSWr/hb t J/rese S. www. t

AugustL3,2Ot2

I ,i
t

rj

Dear Karen Navarrete,

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

Amount due if paid after due

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

iOm arnount dtle

550 Normandy St Apt 2512

Houston,TX 770151

P O Box 660462 Da as,lX 75266-0462

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

Statement Date: 07 123112


Customer name: Karen Navarrete Valued customer since: 11/OB/11

Due Date:08/03/12
Rewards program summary
Points earned this month:1,011
Total pOints to date:8,587

Customer Care:, 18771 282-624fJ


Hours of Operation: Mon - Fri,
B

Account number: A2995064


lnvoice number : Ol 7 DOHT

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

Your Consultant: Karen Navarrete

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

Total Amount Due Past balance due now

58.
ES D:l

166.95

Accouht Details
Houston,TX 77015 3439
1500
l CK

ofl

ESID

alo

Current Plan: Lone Star Select - 12 Month Term Plan

Term End Date:05/13/13

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

Total Ambit Energy Gharges

Page l of3

vina sierra Apa ments 713-451-2142

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,

NoellYoung Property Manager Villa Sierra Apartments

: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

3-7 98-1 900.

F2
DESCR:PT:ON

Total Charges Billed:

$142.00 $142.00
$0.00

Charge Summary: CLINIC

LABORATORY
lnsurance Payments and Adiustments:
Payment Total: Adlustment Total:
Transferred to Patient Responsibility:

$0.00 $0.00 -$142.00 -$104.00 -$33.00

PaJent Payment and Adiustments:


02/27

2012 CASH

03/04/2012 Adiustment

$71.00

Please check box if above address is lncorrect

Please return bottom portion with your payment V

and indicate change(s)On reverse side You may pay yourb:ll

By PhOne at(713)566 6600

By Mailatthe reml address below

CHECK CARD USING FOR PAYMEN



3A/V2

AMOUNT PAID

3ARD NUMBER S!GNATURE


:AMOUNTIDUEINOWi

Make checks,rnoney orders payab!e and rnai! payments to:

EXP DATE

GUARANTOR NUMBER

STATEMENT DATE

$38.00

100406287

07/27/2012

t P O Box 203735,Houston: X 77216-3735

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

ELECTRON!C SERVICE REQUESTED

Account #: Move in Date:


Balance Forward:

02/12/2011

$000

000163010627840

laymen

d;

: 11

V :a Sierra

550 Normandy street

Houston, X77015-3598

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For proper credl,p!ease detach and rlturn thl llper pOnion wlh your payment Thank yOu

RESiDENT ACCOuNT STATEMENT


Property Fees
$723.00
Utlllty Fees

New Charges
S763.06

Balance Fonruard
$0.00

Total Due

S4006

S763.06

Date Due 08 01 2012

unit 2512

CHARGE DETAILS
Property Fees: Rent Scheduled Property Fees Due

llRocklreek

Villa Sierra 550 Normandy Street Houston, TX 77015

$72300 $72300 S1230

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

nd' rc Workerto Vllb Sbrra and rece 7:

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

TOTAL DUE:f paid by 08701 2012:

" 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

Amount due if paid after due

date $

4' 13

To assist other Texans in palng their utility bills,

enteryourdonationanicrrecxtnloox'

$ _-__=_- E

Amount enclosed
Karen Navarrete 550 NormandY St APt 2512
Please make payment to:

$
Ambl Energy

Total

dfFerent from arnount due"

P O Box 660462
Dallas, D

75266-0462

Houston, TXt77015

1 5

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payable to: Arnbit Energy' Please rnail this portion with yotrr payment Make check Keep this part Jor Your records.


8:'7 b

Statement Date: OO|2A12


Customer name: Karen Navarrete Valued customer since: 11/OB/11 Account number: A2995001 lnvoice number: 103H2B41

Due Date:07 09/12


Rewards pro9ram summary
Points earned this month:1,032
Total points to date:7,576

AnnBtTENERG
PUC License:10117

Customer Care:18771282-6248
Hours of Operationi MOn
F

,8 AM to

6 PM and Sd 10 AMto5 PM CT

Your Consuhant: Karen Navarrete

:l1
For rnore infor nation

Account Summary
Previous balance

$
$

8165
(8415)

about residentiai electric

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

Total Amount Due Past balance due now

Account Details

ES D:l

ofi

1 1
1 Current Plan: Lone Star Select - 12 Month Term Plan
JJASCNDJFMAMJ

Houston, TX 77015 3430

Term End Date:05/13/13

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

Total Ambit Energy Gharges

Page 1 of 3

[
100406287

P O Box 203735 Houston, X 77216-3735

PAY THIS

NT

Page Number 1/2


L
:::

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

Thank you for choosing Harris County


Hospital District for your healthcare needs. lf you have questions about this statement, please call us at 71 3-566-6600.

011tiOIIIISTIRAWBIEIRRYl11 75'34
`=1300

Total Charges B:led:

$142.00

Charge Summary: CLINIC

LABORATORY

$14200 $000
$0.00 $0.00
ty:

Office hours: M-F B:00 a.m. - 4:30 P.m.


lf you have any questions after office hours, you can e-mail us

at

lnsurance Payments and Adiustments:


Payment ttotal: Adiustment ttotal: Transferred to Pajent Responsibi

CustomerService@hchd.tmc.edu.

Financial assistance may be av,ailable. i Call us today to learn more. ,

il II ' Harris County Hospital Districtl

$142.00
-$104.00

Sincerely,

: I

Patent Payment and Adiustments:

02/27/2012 CASH
03/04/2012 Adiustment

$33.00
-$71.00

Patient Financial Services

Please check box if above address is incorrect

Please return bottom portion with your payment V

and indicate change(s)On reverse side

You may pay yourb l

By PhOne at(713)566-6600

gD By Mailatthe reml address below

CHECK CARD US:NG FOtt PAYMENT



3VV2

CARD NUMBER
SIGNATURE
AMOt'N=lbllEINOWI

AMOUNT PAID EXP DATE

Make checks, money orders payable and mail payments to:

GUARANTOR NUMBER

STATEMENT DATE

$38.00

100406287

07/05/2012

P O Box 203735,Houston, X 77216-3735

ll L 7L 7 5 7 L L

HA5E
PMor9an

une 16,2012 throu9h Ju!y17,2012

Chase Bank,NA 78265-9754

Account Number

000000994261782

P O Box 659754
San Antoni ,TX

CUSTOMER SERVICE INFORMATION

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

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l11 !:11

llllllli

lllli! 111: 1131]11:

Web site: Service Center: Deaf and Hard ol Hearing: Para Espanol: lnternalional Calls:

Chase.com 1-800-935-9935 1-800-242-7383 'l -877-312-4273 1-713-262-1679

Chase COnege checking

AMOUNT
Beginning Balance
Deposits and Addllions

$4.02

18100
- 18254 $2.48

ATM&DebI Card Wlhdrawals


Ending Balance

DATE
06/26 06/26

DESCR:PT10N

AMOUNT

DeDOSit
Deposit

10595551

1059555

s12100 6000
$181.00

Total Deposits and Additions

DATE

AMOUNT
DESCRIPTION

06/19

Card Pur<;hase

06/17 Rttbox'Dvd Renta1 0akbrkterrace lL Card 1911

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 '',

06/28 Purchase Card Purchase 06128Card

__Vulu l ulv::

=r==rT, === ==== 06/28= Comcast of =__= Houston 713-341-1000 TX Card 1913

rr

$130 272 677 2165 :

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

45 40 ^ 2200 8000 270


$182.54

Total ATM&Debit Card WithdraWals ) r

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

lf you have questions about this statement, please call us at


71

otal Charges Billed:

3-566-6600.

Charge Summary: CLINIC

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

Office hours: M-F B:00 a.m. - 4:30 P.m.


lf you have any questions after office hours, you can e-mail us at

CustomerService@hchd.tmc.edu.

Financial assistance may be av3ita6te. Call us today to learn more. , :

$14200
-$104.00

Sincerely,

Ii I District Harris County Hospital


Patient Financial Services

i]

2012 CASH

$33.00

03 04/2012

AdiuStment

-$71.00

EI F)lease check box if above address is lncorrect

Please return bottom.portion with your payment V

and lndicate change(s)On reverse side


You may pay your bill

By PhOne at(713)566 6600 gD By Mail atthe reml address below

CHECK CARD USiNG FOR PAYMENT



3N/V2

AMOUNT PAID

CARD NUMBER
SIGNATURE
ID IAM00 EI OW

Make checks, money grders payable and mail payments to:

EXP DATE

GUARANTOR NUMBER

STATEMENT DATE

$38.00

100406287

06/13/2012

P O Box 203735,Houston, X 77216-3735

LI L 7 7L LL L 5 L

Christian Tabernacle
Touching lesus, Touching You

13334 Wa isv le

Rd.

Houstoo Texas 77049

713-453-7000 713-453-1617

www.ctab.org
Page
1

Record of Contribu ons

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

300 500 500 500


1000
00

2000 2000 300 500 500 500


1000
00 00 00 00 00

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

Total amount due Amount enclosed

10888

Karen Navarrete t

550 Normandy St Apt 2512

Please make payment to: Arrlbit Energy P O Box 660462


Dallas,TX 75266-0462

'.
L
H
tt B LI L

5 L

ReaSe nla1 1ls po

OnwnhyOurpa

To

Make check payab

O Am Ene9y

Keep this part for yotir records

AnnBtTENERG
uly 10,2012 Dear Karen,

Account Number: lnvoice Number:


Billing Date: Past Due: Amt. Required to Avoid Disconnect: Due Date: Disconnect Date:

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

May 16,2012 thrOugh une 15,2012

Chaso Bank,NA

Account Numbor

000000994261782

P O Box 669754 San Antonio,TX 78265-9764

cUSTOMER SERVICE INFORMAT:ON

00104860 1 AV 0 35
!

550 NORMANDY ST APT 2512

KAREN MATA NAVARttETE

::11[::

1:! 1
[
:

T504694 139

HousTo

Web site: Service Center: Deaf and Hard of Hearingi Para Espanol: lnternational Calls:

1 800

chase.com 935-9935 1 800 242-7383


1-877-312-4273
1-713-262

1679

No overdraft lees for purchases of $5 or less


or less lhat overdraw your acoount' we'll no Good news, we're making changes to help you avoid fees. For purchases ol $5 Fee. This is in addition to in""utri"i"ni rrno"-r?,6, n.turnia ltem Fee, or.ovardraft Protection Transler the business dav' end ol at th or lss by $5 not charging thos-e- i"""'ii yorr u""ornt is overdrawn

;;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

Addill.ln6l Fanklng Servl.es end FeeF,


I

.lnsullicient'FtJnds, Returned ltems, and Slop Paymenls" the lee dsscliptions will be changed to: ln the section ca ed

"--'*-"*;Jii;.t

tnsutlicient Fundl and Ralumed ltam Fees


charqe

u"s eaaiiiniaily,iiii

"iiiig that ls 65 or /ass' or Relurned lldn 'Fee lor any ilem


Overdraft Prolection Transter Fee

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

Change in lees for non'Chase ATM transactions


I

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

Amount due if paid after due

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

550 Normandy St Apt 2512

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

AMBITENERGY+ PUC License:10117


Gustomer Care: (877) 282'624
Hours of Operation: Mon - Fri,
B

Statement Date: OSl23l12


Customer name: Karen Navarrete Valued customer since: 11/OB/11 Account number: A2995Oet lnvoice number: 996J4H1

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

Your Consultant: Karen Navarrete

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

Total Amount Due Past balance due now

Account Details
Houston, TX 77015

ES D:l

ofl

3439

: 1

J:

II

ES10

1
St
average price calculation

h baserde has

Current Plan: Lone Star Select - 12 Month Term Plan

Term End Date:05/13/13

Current Charges
Ambit Energy Charges
Energy Charge (25 days, 582 kwh @ $0.0904) Energy Charge (4 days, 93 kwh @ $0.0936)

5261

chm9 b

Prorated Customer Charqe

870 999

Total Ambit Energy Charges

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

16 days @ $1.8693/day based on a monthly rate

lndudes:Dignd Cttle B L'17rlla

1:ITlll:: a1d Ghalnel l onDemlO i 1


additiona1 0uJet

: : i

.'

el9?I.9_9
Se ice DiscOunt '?ruce,

] R :

-927

16 days@$0 5793 day based on a monthly -1800


discount of$18.00

Service Discount
Di91al Adapter Service

'1 05/24-06/23

000
0.00

Tota:Partial Month Charges&Credits

$9.27

Digital Adapter ServiCe additiona1 0uJet

05/24-06/23

1.3!e charo9

Tota:XFINITY TV

$39,99

State Cost Recovery Charge

.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

State and Local Sales Tax FCC RegulatorY Fee

-29'91

008
$4.35

'. 1 ,.,

Total Taxes, Surcharges & Fees

,1

Adiustments fOr serviCes added 05 08 12


Dignal starter

05/08-05/23

2991

vina sierra

550 Normandy Street

Billing Date:
Unit: Account #: Move in Date: Balance Forward:

05/15/2012
unit 2512
RIV VSA2012042512
02 12 2011

Houston,TX 77015

ELECTRONIC SERViCE REQUESTED

$3802

Tota:Due:
000163009852641 1
(!f pald by 06/01/2012)

$798.78

Amount

Paid:

Check #:

HouStOn, X 77015-3439

2111 it

Make Payments Payable To:

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

550 Normandy Street Houston, TX 77015

$3802

Property Feesr
Rent

$72300 s72300

BoARD Water Conservation Tip:

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

Trash Admin Fee(03/28-04/23)

Flat Charge
Ut

ity Charges and Property Charges Due

TOTAL DUE:f Pald by 06/01 2012:

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

For questions regarding your account,please conta t Management at(713)451

2142

(QESP)10:T011:C 2765:O l:1000:10736774:MSVGlor0000,0001:RPV lC10

P.0.BOX 203735 Houston,TX 77216-3735

bl

l : l

: l

GUARANTOR NUMBER
iSIA 0 IA

:113

Page Number:1/2
151

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,

: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

Charge Summary: CLINIC

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:

$0.00 $0.00 $0.00

at

CustomerService@hchd.tmc.edu.
1

Financial assistance may be available. Call us today to learn more. ; ri i

li

Transferred to Pa ent Responsibility:


Pa ent
02

$142.00
-$104.00

',$ j

Payment and Adiustments:

Harris County Hospital Districtl Patient Financial Services

27/2012 CASH
Adiustment

03 04/2012

$33.00 $71.00

Pleage

check box if above address is incorrect

Please return bottom portion with your payment V

and indicate change(s)On reverse side


You may pay your bill

By PhOne at{713)566 66091

By Mallatthe remn address beloW


CARD NUMBER
SiGNATURE

CHECK CARD USING FO PAYMENT



AMOUNT PAID EXP DATE

Make.checks, money orders payable and mail payments to:

lntlENow 0

GUARANTOR NUMBER

STATEMENT DATE
05 17/2012

$38.00

100406287

P.0.BOX 203735,Houston,TX 77216-3735


LI

ll L Ltt 517 7L L

Tota! amount

due

$
$ 6687

AMBITENERGY
Account A2995064
invoice 960B8F8

Amount due lf pald after due date

bSS
:;

$ i::
Amount enclosed
$
Ambit Energy
P.O. Box 66O462

rf

*Total

diffqat

lrom

amount d@"

Karen Navarrete 550 Normandy St APt 2512 Houston.' TX 77015. 1 rl

Please make payment to:

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.

PUC License: 10117

Y AnnBtTENERG

Statement Date: O4t2gt12


Customer name: Karen Navarrete Valued customer since: 11/08/11 Account number: A29950il lnvoice number: 96088FB

Due Date1 05/09/12


Rewards program summary
Points earned this rnonthi 482 Total points to datei 5,869

Customer Care: (877) 2a2-6248


Hours of Operation: Mon - Fri, B AM to 6 PM and Sat 10 AM to 5 PM CT To repod a power outage or emergency, please call.Centerpoint at (B0O) 332-7143

Your Consultant Karen Navarrete

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)

250 000 684 010 334

l,i'

5356

$
$ $

6384

Total Amount Due Past balance due now

Account Details
Houston, TX 77015 3439

ES D:l

ofl

ESID


Term End Date:05/13/12

Gurrent Plan: Lone Star Select - 6 Month Term Plan

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)

Total Ambit Energy Gharges

$ $

+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

Customer Care: (877) 282-6248


Hours of Operation: Mon - Fri, B AM to 6 PM and Sat 10 AM to 5 PM CT Your term plan expires soon and will automatically switch to a month-to-month plan per your terms of service. lf you wish" to select a different service plan contact 'l customer carc at (877)282-6248. i
)

Centerpoint TDU Delivery Charges


Delivery Rate lncrease 3/20-4/19 Transmission Distribution Surcharges Advanced Metering Charge Energy Efficiency

$
$
$

210
305

Hun lke Restoration Chg


Hurricane lke ADFIT

081

102

Credit

$ -------T
$

(0.14)

634

Taxes and other fees


Energy Taxes and other fees TDU Taxes and other fees

001
60.50

009
0.10

Total Taxes and other fees

Total Current Charges

Miscellaneous Adiustments
Current Miscellaneous Adiustments
Late Pavment fot-af Curre-nt t,tiscellaneous

Penaltv

Adjustments

$ $

g.sa

9.34

Prior Period Miscellaneous Adiustments


Credit Card Transaction Fee

250
2.50

Total Prior Period Miscellaneous Adjustments

1.

Page 3 of 3

l{ext Aopointnentl

tridav,

llav 18, 2012

9:ti

AI

PARTl'll

GIJAROIAl'l: I(AREI,I }IAVAflRIII

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

CLI IC 10: 017 15


S

ART CARO PAN1 5077 1710 1980 4759 02


F10: 100003153839
7

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

BREAO TORIILLAS RICE oAT [AL

2,00 LB : 6t00 VALU[

FRUITS & OR V[G[TABLES

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

1:su[TI [: 12:25P ISSU:DATE:05 0412012


=============3-====
C 3

=====

====

=====

ARIAH

[:

485

01715018'91
I

ll1 1

CITY OF HOUSTON
Municipal Courts

Annise D. Parker
Mayor
Barbara E.Hartle
Director and Presiding

1400 Lubbock,HOustOn,TX 77002-0311


l:

11

1:]1 1
1:

8594

udge 1400 Lubbock,ROom 214

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

550 NORMANDY ST AP 2512 HOUS ONttXlilllil

Arraignment Reminder Notice 04 02 2012

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

SPEED!NG ON STREET OR FREEWAY

FAILURE TO D:SPLAY A VALID TEXAS DR:VERS L:CENSE

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

1. Can I reset mY scheduled

date? NO.youmustchooseoneoftheoptionslistedabovebymail orinpersonatanycourtlocationprior


plor to your scheduled arraignment

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

DiSCRET10NARY"oplon of this ietter

[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

3.How Can:pay my ne?Y?uc payyOurlres byte phone,by ma ,by credtcad Ol by western U

:1 TttT:: :] 1:
Settln

on See instruclons on the back oftns letter

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

md dde and may q andh

P6RTAN

ANY FINES OR CORRESPONDENCE SENT TO THE COURT MUST BE POSTMARKED


41J
Itllis"

RECE:VED PRiOR TO YOUR COURT DATE


`996

DDRESSED 3 trtD BE ttArt S , a),`rrs, ()&), 996,ffr),srtD ,os Z2 ( rl` :


P.0.Box 203735 Houston,TX 77216 3735

L_______ _

04/2472012

IE

100406287

Page Number 1/2


lL
::l::lillil:lilllllilll:]:::illllll:lllll::lilillillil!:ll:

Physician services rnay be b led separately For questions reiated to University of TeXasI
please ca

713-500-3500

HOUS ON,TX 77015-3439


: : IIP

For questions related to Baylor Co ege of Medicin(


please ca 713-798-1900.

MESSAGES
DeaT KAREN NAVARRETE,

DESCR:PT10N

Thank you for choosing Harris County Hospital District for your healthcare
needs.

1: i
Total Charges Billed:

lf you have questions about this statement, please call us at 71 3-566-6600.


Offic611161SI MIIIIloOI.14:30p:

$142.00

Charge Summary: CLINIC

LABORATORY

$14200
$0.00 $0.00

lnsurance Payments and Adiustments:



Payment Total: Adiustment Total:


Transferred to Pa ent Responsibility:

$000
$0,00

Financial asSiStanCe may be 10111,S tOlay 19 19erO mO


:

$142.00
-$104.00

Sincerely,
Harris County Hospital

.i'(. ',

',r,

,i

Pa ent Payment and Adiustments:

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

Please return bottom portion with your payment Y

A fl

By Mail at the remit address below

CHECK CARD USING TdN PEYTUEruT


CVV2
MOUNT

CARD NUMBER
SIGNATURE

PAID

Make checks, money orders payable and mail payments to:

EXP DATE
r

IAMOuNTlntlEINOWI

GUARANTOR NUMBER

STATEMENT DATE

$38.00

100406287

04/24/2012

ct

P O Box 203735)Houston,TX 77216-3735

LI L LItt L 7L L 7

FS:0360667252
1 ii

I l lll lllE

Ccntral File Mailltenance

P o BOX 12048 AUSTIN,TX 78711-2048

OFFICE OF THE ATTORNEY GENERAL SW E OF TF_XAS

lJ,
X77015-34 g HouSTON

5.DiGI = AUTO

77015

CHlLD SUPPORT DiVIS10N

GREG ABBoTT
Attorney Ceneral

Date: April22,2012

ilil:::lll::llll ::::l :illil:: ll::1::::l:llll::::: ll:ll.11::

Si necesita asistencia para leer esta carta' por favor llame al nirmero: (713)150-1442

REPORT OF SUPPORT COLLECTED IN

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

. .

l.row tnttch of the

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)

201067934 201067934 201067934

TOTALS
(See back for additional hfOmlation)
,

S125.001 S18.0

s NO :A

`pe

od eni7011ar cd ng hH chM Support ell eme

Ser ces

by eCh Support Di don

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

March 16.2012 throu9h Ap11 16,2012

AcCOunt Number

000000994261782

San Anlonio.TX 73265-9754

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

site. Sorvice Center

Chase.com

00112569 DRE 201 140 10612 NNNNNNNNNNY T 1 000000

KAREN MATA NAVARRETE 550 NORMANDY ST APT 2512 HOuSTON TX 77015-34391

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:

lmportant lnformation about chase Personal Ghecking 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

we are also exlending how long

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

Those lees may be waived with cerlaan accounl tyPes

@
Beqlnnlng BalanGo
Deposits and Additions

chase college checkrng AMOuNT $693

ATM & Debit Card Withdrawals Fees and Olher WithCrawals

Endlng Balance

59554 -50297 -200


$8364

RETURNSERViCEttL86: +LD

D ar

AV011= easo egard F J K`"n Navarete, ^9T!pN AttQu

: 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

550 NORMANDY ST APT 2512 HOUSTON TX 77015 3439

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

550 NO MANDY ST APT 25i21

HOUSToN Tx 77015 3430

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

9* -.prn .isl:t{Fdlr,.rlltfu st.g.ilq* ___._-1!"_D9?gLEErf .1 -

:t

s72$1I{2PRESGr27

Date: Aprit 09,2012 Account #: OTttl Oi26Og67 OA2

Total Balance: 3140.00


Amount Paid $
Use this coupoi-l6E?E6iEfr6ck or money order. you may also call us toll free al 1-800-COMCAST (1_BOG26& 2278)ilo make I payment with your Msa or other maior qedtudebit card.

@omcost
1 L L7 L 1

nA57ER5 CREDJ70R5 BURFAu JNC. RFTRIFVAL 4 Westchester Plaza,Suite l1 0

COLLECT10N AGENCY
0017270101

Elmsford,NY 10523

htt J h J
l

KAREN NAVARREttE 550 NORMANDY ST APT 2512 HOUSTON,TX 77015 3439

Pin Numberi 35233470231 1 914 345-7136

Apri1 03,2012

Dear Karen Navarrete:

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

1794-AMCA 115861 34647853 Pi 161436 1613:32145290 1:1


653414D (PC'

See reverse side for important information.

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

Exp. Date: Signature: Client Code:

Account Number:
Pin Number: Name: Street Address: City, State ZiP:

44216521 35233470231
Karen Na arrete
DVA LIP 073

!'t

(A service fee of $4.95 may apply.) Account: 44216521

PO BOX 1235 ELMSFORD,NY 10523-0935


:!11:::llllll:lll:: l:l11111il!llll::1!:ll:l:l1llllllllll

RMCB

550 Normandy 2512 Houston,TX 77001

LItt LIP 5

L L 5

+++++ L

Villa Sierra

550 Normandy Street


Houston, X77015

l'

Billing Date:
Unit:

03/29/2012
Unit 2512
RIV

Account #:
Move in Date:

VSA2012042512

ELECTRONIC SERV!CE REQUESttED

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,',

550 Normandy Street

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

REOIDENT A999UNT STATEMENT


Property Fees
$723.00
Unit 251 2
U lity Fees

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

550 Normandy Street


Houston, X 77015

$72300 $72300 S10 $2000


S5 00

: 11

p O,

Q uessaoE BoARD Water Conservation Tip: . Turn off the water while brushing your teeth
day

Saves three gallons each

Trash Co!leclon Charge(02/05-03/02)

Flat Charge
Trash Admin Fee(02/05-03
Flat Charge Ut y Charges Due

02)

S276
$3776
S760.76

TOTAL DUEl

Paid by 04r01 2012:


I

'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

For questions regarding your account, please contact Management at (713)451-2142


(OESP)10:T008:001607:001 :1000:10726680:MSVG)o(OOOO:000.1 :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,,

llll10nS abOut, stltementl Ple9,19a uS at l 713 566-6600:


lf 01 ave

otal Charges Billed:

$142.00

Charge Summary: CLINIC

FIIVIF 110991 II111'9p OFiCI

LABORATORY

$14200
$0.00 $0.00 $0.00 $0.00

ITe
hCnd.tm
9 ?OV
I

!nsurance Payments and Adiustments:


Payment Total: Adiustment Total:
Transferred to Pajent Responsibi:ity:
Pa ent
02

9Y,?mOrse ,,`

$142.00 $33.00
-$71.00

Payme,t and Adlustments:

$104.00

27/2012 CASH
Adiustment

03 04/2012

Please check box if above address is incorrect

Please return bottom portion with your payment V

and indicate change(s)On reverse side

You may pay yourb ...

By PhOne at{713)566 6600. By Mall atthe remtt address below

CHECK CARD USING FOtt PAYMENT


CARD NUMBER


CW2
XP

MOUNT

PA:D

Make checks, money orders payable and mail payments to:

DATE

IAMO NTI 01 INOWi

GUARANTOR NUMBER

STATEMENT DATE

$38.00

100406287

03/30/2012

t P O Box 203735,Houston, X 77216-3735

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

550 Normandy St Apt Houston,

2512 '

Amt. Required to Avoid

TX77015
Navarrete,

I 't i I l;
i

Disconnect: Due Date: Disconnect Date:

He: Disconnect Notice

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

notice. SincerelY, Ambit Energy


PUCT License#10117
records

1
I

'lil

,l

t
_ _ _ _
lercJy

AD 0908

Keep thls part ior yo

nh yOtlr paylnellt Please lna this portion

ake check pa/able tO:Ambit E

Annetr EN ERGY
Account A2995064 lnvoice 925E7D4

TotalAmount Due
Amount Enclosed

$ $

Please include your account number on your check or nioney order.

550 NomandPApt2512
Houston,llX 77015

5 L14

5E7D LI

LL75

: :l

FS:358597578

1 `1 :: : :`11`

Celltral Fllc Mailltcllallcc

P O BOX 12048
AUSTIN,TX 78711 2048

OFFICE OF THE ATTORNEY GENERAL STATE OF TD(AS


CHILD SuPPORT D!V:SiON ==PRSR = =
AUTO 3-DIGl

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:

Date: PIarch 22,2012 Attorncy Gcncral Casc#: 0012301907

0ther Parenti DAVIN JONES

Vea Espafiol al Otro Lado

'

Dcar KAREN NAVARRETE:


We would likc to takc ttis opportllnity to infom you that your Casc has been transfcrred to a new cllild support ofacc:

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

v ofacc. It should takc V Child SuppOrt

ately ten virlilidaySI Om ttC datc OfthiS ICttCr fbr yOur caSC tO reach lhC nc

lank yoll for your,slSrnceandC00perationindlismattcr


l
'

Sincercly,

LOUISE CLARK . HOUSTON INTAKE

Septetrrber 2005

Fonn 5L013E

t
I


.r'l';.rlcrt-$.

lve *,ill c,.e(rte

cr

lrealthier community ancl he re<:ognized as one of America's be.st comrnunity'ttwned huullhtul?

2o BOX 66769,IIouston,TX 77266-6769

tt y'x'. I u' lul o n I i n er. t' r nt


t

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.

Medical Record # 037849472


Thank you,
Referral Center

Phone:(713)873-8890 Fax:(713)634-1017 Hours of Operation:M F@12:()OPM-4:0()PM


I

' `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

550 Normandy St Apt 2512

Houston, 77011
1 11
: )

P O Box 660462 Da as,TX 75266-0462

L ll

5E7D ll

LL75

Please mail this portion with your payment. Make check payable to: Ambit Energy'

Keep this part for your records.

PUC Cense:10117

Statement Date: Ogl23l 12


Customer name: Karen Navarrete Valued customer since: 11/OB/11 Account number: A2995064 lnvoice number: 925E1 D4

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

Your Consultant: Karen Navanete

Account Summary
Previous balance Payments received -- Thank youl Balance forward

For rnore information

about residentiai eiectric l service,please visit il

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

Total Amount Due Past balance due now

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

Total Ambit Energy Charges

Page l of3

EHASE
ATM&DEB: CARD VVITHDRAWALS
DATE DESCRIPT10N (continued)

February 16,201 2 throHC

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

03/08 Card Purchase 03/08 AttM Wihdrawal

O3112 Card Purchase


Total AttM&Debit Card

Houston Card 9893

214 4000 790


$598.50

FEES AND OttHER W: HDRAWALS


DATE
02/27 DESCR:PT:ON
02/27 VNi"hdravva:

AMOUNT

03/02 Non Chase ATM Fee WIh 03/09 03/09 Wllhdrawal

S8812 200 4900


$139.12

otal

Fees&Other Withdrawa:s

Pege 4 ol 4

P.0.BOX 203735 Houston,TX 77216-3735

100406287

IPAY THiS

$38.00

Page Number 1/2


L
lilliH:l:::ll IIillil" llllilillll::::ll: HI 1:::: :::

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

otal Charges Bllled:

$142.00 $142.00
$0.00 $0.00 $0.00 $0.00

Charge Summary: CL!N!C


offiOe hOurS:M F8:oo l: .=4i30p.m.

LABORAttORY
lnsurance Payments and Adiustments:
Payment ttota!:

), hourS,you Can e mall us et e@ 9 .1 91,t9merse 1'lTC

lfyou haVe any ques19 ,after Omce

Adiustment Total:
Transferred to Pa ent Responsibil:ty:

$142.00
$33.00
-$71.00

Palent Payment and Adlustments:


02

$104.00

27/2012 CASH
2012 Adlustment

Pa19,t Finttncia1 0orvi 011

Oo 04

Please check box if above address is incorrect

Please return bottom portion with your payment V

and lndicate change(s)On reverse side.

You may pay yourb l

By PhOne at 713)566 6600

By Mall atthe reml address below

CHECK CARD USiNG FORIPAYMENT



MOUNT

ARDNUMBER

ICVY2
XP

PA!D

Make checks,rnoney orders payab:e and nai: payments to:

DATE

GUARANTOR NUMBER

TATEMENT DATE
03 05/2012

$38.00

100406287

PO.Box 203735,Houston,TX 77216 3735

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.

l(eep this patl for Your records.

AMBITENERGY
PUC Ucense: 101 7
.l

Statement Date: 01 125112


Customer name: Karen Navarrete Valued customer since: 11/08/1 Account number: A2995064 lnvoice number: 856E2G9
1

Due Date:02/10/12
Rewards program summary
Points earned this month:1,032
Totai points to date:3,994

Gustomer Care: (877) 282-6248


Hours ol OPeration: Mon - Fri, B AM to 6 PM and Sat 10 AM to 5 PM CT To report a power outage or emergency, pleaso call Centerpoint at (800) 332-7143

Your Gonsultant Karen Navarrete

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.

$ 9960 $ (102.101 $ 250 $ 000 $ $ 9329 823

$
$

017

10169
101.69 0.

Total Amount Due Past balance due now

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

Current Plan: Lone Star Select - 6 Month Term Plan'

JFMAMJJASONDJ

Current Gharges
Ambit Energy Gharges
Energy Charge (33 days, 1,032

about calculation

kwh

$0.0904)

9329
93.29

Total Ambit EnergY Charges

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

550 Norlnandy St Apt 2512 Houston,I X 77015

Disconnect Date:
Re: Disconnect Notice

0 6r12

Dear Karen Navarrete,

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

Expresi, MoneyGram (receive

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

PUCT License 10117

AD 0908

Keep tl,si)art for youriccords


Please llla this poltlon ith yottr payl

ent

Make check payabic tol AImbit Energy

AMB:T ENERGY
Account A2995064
lnvoice

TotalAmount
890B6H5

Due

[$[$

,r4l

Amount Enciosed

Please include your account number on your check or money order.

Karen Navarrete 550 Normandy St Apt 2512


Houslon,

X77015

5 L `

LI

BLH5

lL

LI

l lll 11111

FS:0354606097

I II

Centlal File Mailltenance

P o BOX 12048 AUSTIN,TX 7871 2048

OFFICE OF THE ATTORNEY GENERAL STATE OF TEXAS


CH:LD SUPPORT DIViS10N
=
38890 i A

0350 KAREN NAVARRETE

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

Date: January 22,2012

Si necesita asistcncia para leer esta carta,

por favor llanre al nfmero: (713)'150-{{d2

REPORT OF SUPPORT COLIJECTED IN DECE lBER,2011.


the month of l)lt(:F]l\'IBllit This is a report of the support rve collected allrl processed tbr your child(refl) during

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

UR INFORMAT10N. OU DO NOT HAVE . The rcPort shows:

CT10N

. .

you received in the Past.

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`

is Whcll you are rccci

1lg aln child suppolt enforccmellt ser ces by ule Child suppolt D ision

Septernber ?010

may have accnred ou the case/cause.

!1 lM
0351606097 Fonn 6L022

ir

@omcost.
Contact us:

Number Date Unpaid Balance New Charges Total Amount Due


Account
Billins

8777 70 126 0367052


01119112.

cOmca .

m e 433 000

$92.90 - Due Now $82.79 - Due 02108112 $175.69 Page 1 of 2

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

News from Comcast


Unpaid balance due immediately. A late fee of $8.00 will apply to past due accounts. Once disconnecled, an activation fee up to $34.95 may apply. Restarting service that requires a technician visit will have a prepayment of a deposit, restart fee, and first monlh's payment. There is a charge for all unretumed equipment.
This bill reflects a change in the FCC Regulatory Fee from S0.07 to $0.08.

Total Amount Due

oXFIMWW Partial Month Charges & Credits


Changes were mada to your account this month. See the tolbwing pagas for mora
detaf,s.

6799
-242

Other Charges & Credits Taxes, Surcharges & Fees

854 868 S8279

lf you do not have a digital box on a television set with


standard cable service or higher, you may be at risk of losing channels 21-52 & 56-80. Please call 7'13-341-1000 to secure tm digital adapters today at no cost. You'll also receive more communication lrom us in the mail in regards to this network enhancemeot and timing for your area.

Total New Charges

ri , li

.: :

With Manilla.com, your Comcast bill, along with your other


bills and statemenls are in one secure place and can be automatically retrieved, organized, and stored for as long as you want and wthoul a fee

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:

Property un:t Status

10714 2512 Current

LeaseFrom Lease To MOVe ln

9/1/2012 3/31/2013 2/12/2011

Address
C:ty St.Zip

550 Normandy Street

#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

:Posted by QuickTrans (deP) chk# :QuickTrans :Posted by QuickTrans

130.18 35.00 95.18 808.18 508.00 500.08 300.18


(199

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

713.00 719.44 732.33 737.66 740.42 860,42 863.00


(2.58)

120.00

chk#372366 92
Rent(11/2011) 713.00
13.52 6.76
5.33

710.42 723.94 730.70 736.03 738.79 715.00 50.00 23.79


(26.21)

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

713.00 726.25 732.87 738.20 740.96 840.96 790.96 830.00


(39.04)

12/1

2011

Sewer(12/2011)
Water(12 2011)
Trash(12 2011)
B ling

12/1/2011 12/1/2011 12/1/2011 12/12/2011 12/12/2011 12/12/2011 12/16/2011

Fees(.12/2011)

rent was Daid on the 9th. They refbrred #1914-application verified

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 #:

M ake Payments Payabie To:


Villa Sierra
I

550 Normandy St Apt 2512

1 i
l

550 Normandy Street


Houstoni ttX 7701 5-3598
:::lll :ill::!ll:lll:::lll:

::ll:!::lllll:::l:l]]1llll

::

Foi' propcr cledit, please detach and reiurn the uppei' poition wi'th youi'payment. Thank you

RESiDENT Ac99 Ntt STATEM NT


Property Fees
$723.00
Ullity Fees

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

550 Normandy Street

HoustonittX 77015

Q uessece BoARD
Water Conservation

sewer Base A ocation(03 02-03 28)

$2000 , $000 $500 S276 S3776


S760.76
f

RUBSil Unl X 20
RUBSi2 0ccupant X 0
Trash Conec10n charge(03/02-03/28)
Flat Charge

Sewer Exp Occupant A ocation(03/02 03/28)

Trash Admin Fee(03/02-03/28)


Flat Charge
u nty

charges Due

TOTAL DUE lf pald by 05 01 2012:

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

For questions regarding your account,please contact Management at(713)451

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
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jtter Repo

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111

1111, ,1

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Re ew

'PM

ptt EleS

Encountts tLabstil

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l: 11111: 19 ILette,1lmQlllLi
All C le

4,

::il;

paJ.u,,'i' 1'.'io! t' r',4


ofrce
isn

No lilters applied

02/27/2012
0121

FAMPST
IFAMPST

Okoh, enn fer O,MD


O :life10,Mpl

Heanng lrrpairment(

11 03/182011 0929/2010
09 7/2010

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KAREN NAVARRETEl MATA

Page 2 of 3 Statement Period

B06

l2-11-08

through

Number of checks enclosed: 0 Account Number; 6860 0794 9824

APPA

01-09-09 6

MyAccers Checking
KAREN NAVABRETE.MATA

Your Account at a Glance


Account Number

ms i

586007949824

&

MyAccess Checking Addirions


12 17

B::::::

12 17

10,00 10.00
$ZO.OO

Total Deposits and Other Additions

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:

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KAREN NAVARRETE MATA 450 NORMANDY ST AP 314 HOUS ON TX 77015 3469

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

MyAccess Checking KAREN NAVARRETE MATA

Your Account at a Glance

B i :f ttl

;& : `J :
i

9824

Dqily Bolonce Summory


Beginning

Harr

Cou Taas(R"02")

Fee Offlcer's Official RecelPt

THE PEACE, PRECINCT 3 PLACE PARROTT 14350 WALLISVILLE ROAD SUITE 02 HOUSTON TX 77049 4135 ( 7 3 )450-2409

USTICE OF UDGE MIKE

W
Ma

50.00 50.00

:cASH

Payment Amount
Change nemitted:

.00 Receipt Description:PARTIAL PAYMENT

TR3 X0383771

VS.

THE STATE OF TEXAS KAREN NAVARRETTE 450 NORMANDY #314

Card/Money
Fel Number: Auth Code: Slgnature:

Exp
Date:

NAVARRETTE KAREN

HOUSTON

TX 770 5
Payor's Copy

Received By:

u8 B

Tampa FL 33622 6118

Bank of America,N.A. P.0.BoX 26118

Page 1 of
06-11-09

Statement Poriod

806 0 APPA 6

throrigh 07"13'09'
014

Numbor of chocks enclosed: 0 Account Nurnber: 6860 0794 9824

111:]:1111

:ll

l]

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1:1::!11.1:l!

KAREN1 1lVARREttE MAttA 409'001 SCM999

450 NDRMANDY ST AP 314 HOuSTON TX 77015 3469

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'

Parents, want your teen to learn about finances?


Ask them to visit our Web site, bankofamerica.com/studentcode. lt's a free and easy way to learn good money management skills, how to create a budget, etc. And by visiting a local banking center, your teen can sign up for our Student Package, featuring CampusEdge@Checking and award-winning Online Banking.

Bank of America,N.A. P.0.Box 25118


Tampa FL 33622 5118

Page I of 3 Statement Psriod


05'09-09

806 0 APPA 6

through

06'10-09
01,

Number of checks enclosod: 0 Account Number: 6860 0794 9824

: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

MyAccess Checking KAREN NAVARRETE MATA

Your Account at a Glance


Account Number Balance on 05-09'09 Besinnine " Servi-ce Charges and Other Feee Ending Balance-qn 06-10-09 !

586007949824

: 1

MyAccess Checking Subtroctions

Monthly Maintenance Fee l

06 10

8.95

Total Ser ce Charges and Other Fees .95

Bank of America,N.A. P.O Box 26118


1:alnpa,FL 33622 5118

. d :
04 11 09

B06 0 APPA 6

thl'ollgh 06

08 09

011

Number oF checks enclosed:0 Account Number:6860 0794 9824

l!: :!::

,11

:lllll:]ll:

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1]::

KAREN NAvARRETE MATA 450 NORMANDY ST AP 314 HOuSTON ttX 77015-3469

l1099 001 SC 999

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

KAREN NAVARRETE MATA

Page 3 of 4 Statement Period


04-11-09

B06 () APPA 6

through

06'08-09

OIi

Number of checks enclosed: 0 Account Number: 6860 0794 9824

MyAccess Checking Subtroctionr

:::

i1
Balance($) Date
04 20 04 21 04 22

04 17 04 20 04 21

Tota1 0ther Subtractions SO 92

Date

Balanee($)

Date
05 08

Balance($)
48.34

F
04 17

ng

2.48

145.52 143.52

11

1'I

Bank oF America,N.A. P.0.BoX 25118


Tampa.FL 33622 5118

Page 1 of 6 Statement Period


03-12-09

through 04-10'09 O APPA 6 Number of checks enclosed:

B06

()II
0

Account Number: 5860 0794 $824

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'

lmportant tnformation Regarding Changes to our Deposit Pricing


please see the enclosed brochure for information about upcoming pricing changes to some deposit accounts. ln addition, we've included information on how to help prevent or minimize deposit fees as well as details on improvements we've made to serve you better, lf you would like more information, visit bankofamerica.co m/prici ngchanges

KAREN NAVARRETE MArA

oiod ::
03 12 09 through 04 10 09

306 0 APPA 6

011

Number oF chocks onclosed:0 Account Number:6860 0'94 9824

MyAccess Checking Sublroctions


6 Withdrwl BkofAmerica ATM 03/14 Houston Northshore \{ithdrwl 03/15 #000008380 ATM BkofAmerica East Houston Mot Houston TX Normandy Food 03/15 #000215500 Purchaee -'isa Noimandv Stre Houston TX
03 16 03 16 03 16 03 16 03 16 03 16 03 16 03 17 03 19 03 19 03 19 03 20 03 20 03 20 03 20 03

4000
2000 1156
6.48

s"r;;
Ct::

CheckC[1 0313xC
:llf

164 ' 03/15 #oooTo4ooo W ::la 111

Purchase

31[11:

::J:l::::12460120
2900010600129

573 500 324 4619


12183

':J;l::

4000 3000 2500

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

KAREN NAVARRETE MATA

: II enod
03 12

B06 0 APPA 6

09 throllgh 04

10

09

015

Number oF checks enclosed:0


Account Nllmber: 5860 0794 9824

MyAccess Checking Subtroclions


Monthly Maintenance
Fee

Total Serviee Charges and Other Feee $6.96


03 12 03 13 03 16 03 17 03 19 03 20 03 23 03 30 03 31 04 01 04 02 04 03 04 06 04 07

2.54 0,99 1,99 0,81 0.17 0.98 2.17


1.17

0,83
1.47

0.20 1.29 1.92 0,68

Tota1 0ther Subtractions$17.21

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

127.47 183.47 49,47


2.47

68.47
13.47

153.47
3.47
2.48

161.47

193.47 141.47

Bank of America,N_A. P.0.Box 26118


Talnpa FL 33622 6118

Page l o'6
Statoment Period
02 07 09

B06 0 APPA 6

throllgh 03 11109

01

Number oF checks enclosed:0 Account Nllmber:68600794 9824

ll

1lll 1llll

1ll:

]:[!lill]:!::11:l

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1 1

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HOuSTON ttX 77015-3469

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12099 001 SCH999 11

1,TA314

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h and m M ' y tis statement eS Thili ? : Ter statement. Enrdl tt www.bankoLm

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

KAREN NAVARRETE MATA

B06 0 APPA 6

through 03

11

09

016

Nllmber oF checks enclosed: 0

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

20.56 20.00 20.00


10.81 10,00 7.66 3.66 1.94 1.06 5,41 2.13 10.00 9.78 3.87 3.29 1.83 1.18

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

02llg #000427311 Purchase

Kroeer

Woodforest Houston

02/18 #00000Q4i71 Purchase

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

CheckCard 0220 SubwaY #6434

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

KAREN NAVARRETE MATA

Page 5 of 6 Statement Period

through 0$'ll-09 ()IT O APPA 6 Numbsr of checks enclosed: 0 Account Number: 6860 0794 9824
02-07-09

B06

MyAccess Checking Subrtroclions

::] : Elil::II:1: III: :::::l For 03/09/09

For 03/05/09 For 03/10/09 For 03/11/09

03 05 03 09 03 10 03 11

:: : 8 :1::I :1: IT: :::::;:

0.26 1.90 0.87 1.07 .30

Tota1 0ther Subtractions$

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

9.42 4.42 2.42

174.42 105.42 99,42


96.42 76.42

04 05

126.42
15,42

266.42

i ll

Page 2 of 4 Statenrent Period

KAREN NAVARRETE MATA

0l-10-09

B06

through

Number of checks enclosed: 0 Account Number: 6860 0794 9824

APPA

02'06'09
6

MyAccess Checking Additions

1
v 9
1::::

01 26 01 29 01 29 02 02 02 05 02 06

11.00

20.00
20 00

60.00 51.00 87.00

TOtal Depo8itS and Other Additions l 49.CDID

MyAccess Checking Subiroctiong


Wal Wal-Mart

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

CheckOard 0201 Roman Dellght' Valero

TX

244273390$2?200207 28558

Sellers Bros
Subwav

Pasadena TX 2M92809033118000193367 #25t7 OZl03 #000266600 Furchase oCa Pasaaena Blvd Pasadena TX

F 02104 #000265700 Purchase Houston T)( 1202 Uvalde


#64e4
161 Pasadena

04 04

Town Pasadena TX

O2lO4 #000951600 Purchase

Cheek0ard 0203 SubwaY #6434


Valero

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

TX2442i339035710009680851 02/05 #000507200 Purchase

22.00
19.54 10.00 5.41

T)( East Houston Subwav #6434 02106 ffi00743700 Purchase 161 Pasadena Town Pasadena TX

BIC Houston

Total ATM and Debit Cad Subtractions$129,90

KAREN NAVARRETE MATA

Page 3 of 4 Statement Period


0l-10-09

through 02-06-09 O APPA 6 Number of checks enclosed:

B06

OIO 0

Account Number: 5860 0794 9824

MyAccess Checking Subtroctions


Monthly Maintenance Fee ll
5.95

Total Service Charges and Other Fees



-

$6,06

4.79 1.59 0.32 0.35 1.05

Tota1 0ther Subtractions S8 10

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

Page 2 of 3 Statement Period

KAREN NAVARRETE MATA

806

11-07-08

through

Number of checks cnclosed: 0 Account Number: 5860 0794 9824

APPA

12'10'08
6


Go Paperless.

MyAccess Checking KAREN NAVARRETE MATA

Your Account
Account Number

i
Deposit
'I

m8

586007949824

& g 1 il

MyAccess Checking Additions


12 04

10 00

TOtal Deposits attd Other Addition8$10 00

Date Beginning

Balance($)
56.63

Date
12 04

Balance($)
46.63

KAREN NAVARRETE MATA

Page 2 of 3 Statement Period

806

t0-11-08

through

Number of checks enclosed: 0 Account Numbor: 5860 0794 9824

APPA

11-06-08
6

MyAccess Checking KAREN NAVARRETE MATA

Your Aceount at a Glance

iittifl

Account Number

586007949824

gr ::lg : 1
:

Doily Bolqnce Summory


Date
Balanc ($)
56.63

Beginning

Page 2 of

KAREN NAVARRETE MATA

Statement Period
09-11-08

B06 () APPA

through

10-10-08
6

Number of checks nclosod: 0 Account Number: 5860 0794 S824

MyAccess Checking KAREN NAVARRETE MATA

Your Account at a Glance


Account Number Beeinnine Balance on 09-11-08 " DepoEits and Other Additions Service Chargee and Other Fees Ending Balance on 10-10-08

l
$

g 1 ::
56.63

MyAccess Checking Addiiions


,osiit and Other Additions
Deposit

Date Posted
09

Amount(
10.00

23

Total Deposit,and Other Additions$10000

MyAccess Checking Subtroctions

_rl
Monthly Maintenance Fee l)

10

10

5.95

Total Ser ce Charges and Other Fees 16.95

,9ily B :
Date Balance($)
60.68

__
Date
10 10

Date
09 23

Balance($)
50.68

Balance($)
56.63

Beginning

Talnpal FL 38622 5118

Bank of America,N.A. P,0.Box 25118

1 riod :
08 12

B06 0 APPA 6

08 throllgh 09

10

08

011

Nlimber oF checks onclosed:0 Account Nllmber: 6860 0794 9824

ll

1]!

11, l

::! l]: :::11 111]: ]l 1:]:1 ll 1:l

::111:

110'9 001 SC
M

999 1

5 0

10][ 't :[: [: TA HOUS ON TX 77015 4323

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.

Bank of America, N.A


P.O. Box 26118

Page

I oI 4
through
08-11'08
O1I

Stat6ment Poriod
08-0?.08

T6mpa, EL 33622'5118

B06OAPPA 6

Nuinbsr of checks encloied: 0 Account Numbr: 5860 07S4 9824

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'

Bank oI America Muteums on Us@

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.

receive free admission to over 70 museums nationwide with

I50

,u""rr"

,ri.rri.

Bank of America Mall'"1


Save up to ZOyo at top retailersl Shop Bank of America Mallrr website and save with discounts from hundreds of retailers. To get started you need a Bank of Amerlca Check Card or credit card and enroll Onllne Banking. Visit ba nliofa merica.co m/shopping for terms and conditions.

In

KAREN NAVARRETE MATA

: fettoHod
08 07 08

B06 0 APPA 6

throllgh 08

11 08

0187

Nlllnber oF checks o CIosed: 0

Accotint Nllmber: 6860 0794 9824

MyAccess Checking Sub,troclions

03/10#000491d3b l lnq
dy

Total Service Charges and Other Fees


08 07 08 08 08 11

$2.00

::Il::I:i:::::i:[illi:::::::::!:::

0.56 0:35 1.48

Tota1 0ther Subtr ctions .89

Ddly Balance Summary

________

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

MembeEhip Type Workout

PERSONAL:NFORMAT:ON

/ /

ACCO

NAVARRETE

as rvame

Mlddle

mployet

mOer

sL

Member Name KAREN NAVARRETE ACCOUNTING AND PAYMENTS

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

Tolal Recurino Total Amount Paid Today Xemaining Balance

Dues lnveslment

$0.00 $0.82 tti 7a

S995

$2500 32804

$5,JO4

Abovo romaining b8llncs to be paid s! lollow!:

l tti
: Contracl Star Date:6

:: ::l :]

1 072008

nn Ce : : :, i l 1111: :: l;W First Dran Date:7


172008

Apep d

I suthorize Fitness connection

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

monthlyduesandthepro@ssingreedaemedlobeproratedoverthetwenty-fourmonths. F-itnessconn"iionriflnot""n*lthemembershipduring lhetweflty-fourmonlhperiodwithoulcaus. Furlher,aslongasthememb;rlsingoodstanding.

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

parJf,l: on behalf of mv minor child and myself,

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:

Date Sbned Counselor,

Authorized by Filness Connection

[VV 2

[In t

Verification of BiFth Facts


that will appear on the !nfant's Birth Certificate
This doculllent verifles that MARIAH

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)

, and was delivered

This was a

birth that was born


tlr SINGLE Lcavc Blank)

The mother's maiden name is

KAREN

NAVARRETE
(MOthCrs Namc PHorto First Mal agc)

who was
at

born 09 I

21 / 1988 in

MEXICO
Bi h) (MOthCrs Placc

and currently lives

(Datc o 0' 11)

794 NORMANDY#lH5
(Slreet ,\ddrcss or Rural Localion)

which HARRIS
(Courty ol Residence)

iS
IMS,01)

inside the city lirnits of

HousTON
(City OI Rcsidence)

County,

TEXAS
(State of Resideilce)

77015

The mother's rnailing ado ciS

i3213

KNOLLCREST

HoUSTON
GISELL

EXAS
JONES

77015

The itllcr of MARIAH

lS DAVIN

ONEAL
(Fatheis Name)

JONES
I=OUISIANA
(FaLher's Place

who was born_lQ / 10_/


(Datc or B,:lh)

1985 1n

of Birrh)

have rcvie

the inlorymation alrqw

atitisc
.

'fhe penalty for knowingly

nlaking a false statelllent in this fbrnl can be 2-10 years in prison and a tlne of up to S10,000.

(Health and Safcty Codc,


1

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

RIAH GISELLE JONES


utsido d 4b C olTmo t,91ve pr

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

EAST HoysTON RECIoNALMFDICAL CttTER


98 Cerun

Attendant

KIMBERLY HAWKINS

jOANp INI

3b u MD E DO u CNM D mmlle uolnerlspealy

.D.
lo Momers Name rnOrto r

Facility Administrator or Designee


:Marnago
lZ U

re,9n Place(S te.lemlory Or

KARttI

NAVARRE E
tp

09/21 1988
C ,T m or LOCallon

MEXICO

13d uetAdms30rR Local n

TEXAS
130 41p cooo

HARRIS
1 nsloo w ul

HOIISTON l
9Att IISarne

794 NORMANDY
:o

'
/

77015

11213KNOLLC= iioIIsTOtlTEXA'7701:
Middlo

15 Fahers Nalne nst

surlx

10 0ate o1 6Mh(mmdabl

17 3mplaces L,TmloFy"F

"n Coun

DAVIN ONEAL JONES

10/10/1985

LOuISIANA

18a.tsd

Fils Number

18b Dale Rece ed by L cal R,91star

'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

CODE EACH ITEM AS FOLLOWS

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,

cor.rJuNCM, nlo ntFlu)

: ll
rrNclUirvc
.LuNGS

enEAsr
I I I

'

DIET2

Application for Certifi cateiAPPlicacion para Certificado Bureou ol Vilal Statistics OSPHP

Phonc No. (Numcro dc

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

(Esrado) -7r \l-i(rni,-r ffimindando iilA;dt


Srare

17otb
Porconcro)

ziP (-od (zom posrar)

i,,

,r

..t" *

ts !*re'dLt" nt t',r,,Jcrthte'
'

W (
`

Signed

Size

Complcto)

S2300 S2300
Fact aclo dc Nacimiento)

S2300 M dc Nalrr segttdo

To youF knOWiCagc,has cre siha echo

cver bCen a

.rr-g.,

"d.p,i;;-. "t*.dmcnl
c"t

filcd to this

lf

so, please explain es, cxpliquc

algur- en-ienaa o udoPcioot

-o
Certirlcad S21 1Xl

Sigl
Solterola)

Extra $41111

M3medr
Casadola)

Widowedl
Viudola)
volced Divorciado13)

: 1 ll j L caDl 0"'

MESSAGE

FROM

SOCIAL

SECURITY

INFORMATION ABOUT WHEN YOUR BABYiS SOCIAL IMPORTANT:

YOU WILL RECEIVE SECURITY CARD A SOCIAL

NAMED YOUR BABY CARD CANNOT BE ISSUED.

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

your caseworker when you rece

Ve your babyrs

Social Security card.

Form SSA-2853-OP3 (6/89)

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

Congratulations on the birth of your new Little Texant


TexasVital Smtistics would like to take this opportunity to answer some most commonly asked questions about birth certificates in Texas.

"How do I get a coPy of my baby's birth certificate!"


You can request and purchase a certified copy of your child's birth certificate from the local registrar's office located in the city or county where the birth occurred, or from theTexasVital

Statistic office located in Austin,Texas.

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.

my baby's social security Gard," "When will t receive ,t

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

East Houston Regional Medical Center

NAVARRETE,KAREN
D

Birth C61tificat ih161mation


(1/4

Acct :AE3007968697 M R#:AE00323690 DOB:0921788 19F Loc:2831 A

HaWkins Kimbe

12111/07

Form VV

2 VV

and Tax Statement


and ZIP code

,ops,Other compensalon

827.76
827.76

Employer's name,

security lax

YOUTH ADVOCATE PROGRAMS 2007 NORTH THIRD STREET HARRISBURG PA 7 02


e Employee's name,address,and ZIP code

INC
10
Depsndenl care benelits

5
5 Medicare wages and lps
6 Medicare tax withheld

.33

2.03
for box 12

0.00

KAREN NAVARRETE 322 KNOLLCREST HOUSTON TX 770 5


1 5 State

Em oyer den icatbn number( N)

23- 9775 4

Employee's s@ial

ssurity number

TX

Employer's state lD number

16

State wages, tips, etc.

827.76

Stale in@me tax

0.00

1 8 LocJ wages,IPs,e

827.76

19

Local income tax

o,

20

Localily name

Q0
reasury
Visl lhe lRS website al lt/ rs g /eFllp

With Emp: yee's FEDERAL Tax

This infomation is being fumished to the Inlernal Revenue Seruice.


OMB No. 1545-0008

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.

W-2 Waqe and Tax


Employers name,address,and ZIP code

Statement e005
INC.

S&ial security tips


Allocated lips

l WageS,lps,other compensalon

827.76
827.76 827.76

2 Federalincome tax wnh old


4 Social secuttty tax wlhheld

9.83
5

I I

3 SoCial secunty wages

YOUTH ADVOCATE PROGRAMS 2007 NORTH THIRD STREET HARRISBURG PA 7 02


Employee's namo,address,and ZIP code

.33

Advance EIC payment

10

Dependent care benbfits

13 ] %

o-oo 0. 00 t

5 Medtare wages and ups

6 Medicare tax wlhheld

2.03

Nonqualified plans

0.00

12a See instruclions for box l

1 4 01her

KAREN NAVARRETE 322 KNOLLCREST HOUSTON: TX 770


1 5 State

b Employo

iden lca

on number(EIN)

23- 9775 4

d Employee's socia secuttty number

5
1 6 State wages, ps,elc

936-79-4692
State income lax

Employer's slate lD number

TX copy

827.76

17
_.-_

1 8 Local wages,ups,etc

'19

""

0_,,-0-_0

827,76

Local income tax

.-"

..- .

0:00

20

Localily name

For EMPLOYEE'S RECORDS(See Notice to Emp!oyee on

oilB No. ls4s.oms

reasury
visnthe lRS website at www llS g
r le

:pII ellt.:f lreastiry


lliernal R entle Se ioe

98296130112597

2821722545

Philadelphia,PA 19255

Notice Date:05/28/1997 Notice Number:C P565A IN:936-79-4692

KAREN MATA NAVARRETEl 1219 DEWEV ST HOUS ON ttX 77015

For assistance ca us at:

(2151516-4846
0ryou may wrile us ati

P.0.Box 447 Bertsalem,PA 19020


NUMBER(TTIN) W E ASSIGNED YOU AN IRS INDIVIDUAL AxPAYER IDENTIFICATTON

Than6 you for your Form w-7, Application Number, we assigneo you n'lN

toi lns

936-79-q69?

lndividual Taxpayer ldentification Please keepthis notice foryour records'

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

5,pleasc Ca us d tho nu ber" nd u i aily

ahove

ELEMENttARY, INttERMEDIAttE,MIDDLE&

SCHOOL RECORDS
HIGH SCHOOL

FROM
05/09/1995
O

10/08/2007

Marque Learning Center


13301 East Freeway #304

Sales Receipt
Date
10/8/2007 Sale No. 1208

Houston, TX77015

So:d o

Navarrete Knollcrest Houston Tx


Karen
13213

I
r

770t5

neiutts in

5 business days, Diploma

*ittrin Z l/2

weeks

Total

$o.oo

713-453 0310

Marque

Lea' ing Centet


#
304 A Private Home School Orgarrization

13301 East Ftee .ay

Houston, T)i ?l C15

Tranecripts Katen Navartete Name: 13213 Knolcrcst Address:- Phone: _ _ 832-20 4817 ^ Semestet
Couree English Math

Social Security

936-19-4692

==

City & State Zip Code:

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

!0ork Study Total Creditsr

G".d. 927 86 78 88 100 100

1
1 1 7

Total Ctedits:

24

Date of Graduation: October 8,2007

For inquiries: 713-453-0310

RING ORDER FORM


provide you with a ring Your ring is designed and manufactured by the finest craftsmen. lt is our goal to complete your ring order form and mail Please the ordel of is 6 weeks from receipt ring made cuslom this time for Manufacturing -enclosed (50s) 223-3931 Should you need additional to you it fax may self-addressed, stamped envelope or it using the not accepted' are checks Personal (5OB) 223-3400. NQfE: assistJnce, please call Lenn Arts at you will be proud

oi

MARQUE LEARNING CENTER MEN'S RING

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

Men's 14K YG Ring


Men's 10K YG Ring Men's Sterling Silver Ring Shipping & Handling TOTAL COST OF RING

1250

MARQUE LEARNING CENTER LADiES RING


Sterling Silver

Ladies 14K YG Ring Ladies 10K YG Ring


Ladies Ster ng Silver Ring

$ $

Shipping&Hand ng

1250

TOTAL COST OF RING

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

campuS COde Nurber 443408

Program Type

Lang Arts

Mat

Science social studies

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,

cotrtcnt, X'Innovatlw, clant lndlcttlon g-14-06

Enroll ln

I.l/D 1l-13-C5
Home School


FOR LOCAL USE STANDARDIZED TEST RESULTS

ACADEMiC ACHIEVEMENT RECORD SENT:

REQUESTING AGENCY

DATE SENT

ADVANCED MEASURE REQUIREMENTS COMPLETED FOR THE DISTINGU:SHED

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

ROSARIO ORTIZ 13221 KNOLLCREST ST HOUSTON TX 77015

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

Exces ive Ab sences,No Credit

Lttf i:1
U=UNSATISFA(

: Adviso :H rl1lde2 1 , 1 1: 1 1 ING . :111


RY

PROGRESS REPORT 1 2005 06

ORY

ROVEMENT

'

111

CRDTS ABS TDY


0:UUU : =: = U

CZ

PRl

vreber

ORK FAILED TO TURN IN HOME

TT

li

NEEDS MOR [FFORT ON CLASSWORK

FAILED TO TURN IN CLASSWORK


Credit Rec A
RhOd
S J

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

See Reverse Side For Eosy Opening lnslructions

Galena Park Independent School District North Shore Senior High School 353 N. Castlegory Houston, fX 77049

PRESORttED FIRST CLASS MAIL

U.S.POSTAGE
Pald l oz.

Permit No.565
RETURN SER iCE REQUESTED

Parent or Guardian of:

Karen Navarrete 13221 Knollcrest St Houston TX 77015

'"

"oi DATES: 0B /L5/05 To t2/15/05'


PERIODS:

iii""i"5""

t cns Di

0 TO B

RUN DATE: 10 /2O/05 THRESHOLD: 3

STUDENT:

'

KEY: NAVARKARO00 AGE: L'l ADVISOR: Shif let GRADE: l-0 PHONE: (713) 455-0565

Karen Navarrete

ROSAR10 0RTIZ 13221 KNOLLCREST ST HoUSTON TX 77015

ATTENDANCE INFORMATION FOR: Karen NaVarrete PERIOD: 1


____ ERIOD ABS CNT

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

vouTH ADVOCATE PROGRAMS,iNC. 2007N3RD STREEtt HARR:SBURG,


1 1lF': ,IIlt,F
F

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
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0 (1

1.

101V .00 .00 oo

II I11

:IIll

AL

:{:A/FIII 31CArt

11 I
11)'I ttt

I F tt V

P CR 00 00 .00 cuRRENT .04 t3.53 00 00 6_81


( (

PIIE

VAC
C)0

51CK
C)0

=RIT

HlSC.
r ."8 .3

TAL

.00 .00

00
()(D

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BERTItA RODRIGUEZ
5tartl

111

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3100 FM

I F
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daY

Navarrete
Weeks Report Card Grade:

FIFTH 6 WEEKS 2004-05

PLEASURE

?E NEVT IN CLASS

is for the 5th six weeks period only.

,,

The Assocaation for

fle
:

Advancement of Mexican-Amedcons

Nm
Dcpamm
Cmpm 1

/ /4 2

Date: /zl / tt TmC1 7: (^


The Artodrtlon

#ofPage

fot

TLc Advucrmeot of

FrxNumber:
Phone Numbr

7t?- ZzZ - /o t/ t .
I

Mcicrn-Arerlcoor

'

Address: 8001 GutrFreeway

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 /*

u" y''-e y'.

'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

Karen Navarrete's suflmary at

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.

Uncl Chvez LAOM House Case Mana8,r 713 921 1188

HIGHPOINT SCH00L EAST /1THDRAWAL NOTIFICAT10N


Student Name:
Social Security Number:

District:GALENA PARK ISD

DOB:
8/25/2004 Reason For Withdrawal:
Inc.

Withdrawal Date:
Agency/Person Requesting WD:

IIPE

STUDENT ISINCARCERATED.

Student's grade average for this semester:


Clsss

& Period

lst
2 d

II A

IA
Ed II A

3rd
4th
5th

ISI A
IA

6th VVorld IIIislorv A


* Dnotes the student was denied credit due lo excessive absencs East Schools serve as an Alternative Educational Ptacement School

fol 9 Districts'

concerning this student,Please colltact hiS home campus or home school district

OF

Counselor Sign.lur

SrhoolScal

Plersc Route Thir Form 'I o The Follolrlng Perlonoel


(PiCaSe lnitial)

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

has been lost, Cost is $35.00)

Principal

sTU# LAST NAME 2322 NAAl ARRETE


1

FIRST NAME KAREN

M/1 PERMANENT# oo00202272

SEX GRADE TRACK S/E STATUS 09 F

4: I:l:;181E t----ild;- ----;;;;;;--- ,"*'38,*HBP"*"' -;,,*!pr;


ABS

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

CODE: ALL: GET LAST NEXT

PRESENT

TOTALS

tINDO

XFER

C r

O/C C
J

Presented to

For the Successfull Completion of

A.A.M.A's Barrios lJnidos Intervention Program


Presented by

Tbe Association

fo,

tbe Adadncement of Mexican Americdns, Inc.

Hea1th and Human Services Division 204 C[fton Street, Houston, Texas 77011

Presented on this Date

7-c-o{

Intervention Specialist

Highpoi-nt SchooL East 8003 E Sam Houston Parkway Houston, TX 77049

ID

3415

Navarrete, Karen
04/12/04

Grade 09

Sixth Six Weeks Teacher Chret ien, McPeters,


Hausmann,

05/27/04

Course

Academ c Marks 5th 6th SEM SEM 6wk 6wk EXM GRD

Attendance CUR SEM Credit ABS ABSCitzEarned

Physical Ed I B English I B Hea I th World Geography Algebra I B Biology I B

Rhoden, G Clay, Dr. Wilson, J

70 90 50 89 70 50

96 55 50 61 70 50

65 65 50 64 59 55

'

PAGE l OF l

CONDUCT NlARKS (CitZ) o = Outstanding S i SatiSfactory N = Needs lmprovement U = Unsatisfactory

INC : Incomplete

RE: Karen Navarrete

Houston, TX 11049

Teacher's Signature: Parent's Signature:

Highpoint School East 8003 E Sam Houston Parkway Houston, TX 77049

ID 3415

Navarrete, Karen
04/12/04

Grade
09

Sixth Six Weeks


Teacher Chret i en, McPeters,
Hausmann,

05/27/04

Course

Academ c Marks 6th SEM SEM 6wk EXM GRD

Attendance CUR SEM Credit ABS ABSCitzEarned

PhysicaJ. Ed I B English I B Hea] th World Geography Algebra I B Bi-ology I B

CIay, Dr !'li I son. J

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

RE: Karen Navarrete Houston, TX 77049

Teacher's Signature: Parent's Signature:

GRADE SU

sTU# LAST NAME

2322 NAVARRETE

FIRST NAME KAREN

MIDDLE

NAME

PEttANENTI 0000202272

SEX GRD STATUS F 09

PAGE O OF 02

TITLE 1 ITRMI : lcouRSE + + +


2 2 2 2 2 2 2 2

PRDlg

18

: M
+

:1 II

402502 3 3502 2 502 8 0000 789502 5 3000 5 0000 02502


78950 0250
8 5000 2 50

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:

CLASS RANKING: 045

DAILY ATTN: 0.0

ACAD GPA:

0.225

TOT GPA:

0_225

FUNCT10N CODE: A=ADD B=BACKUP


Su4GRF

LINE ll: C=CHANGE D=DROP


1:19:07

E=EXIT

F=FORWARD

G=GET

L=LAST N NEXT =HELP F2=MENU

4/23/04 TIME:

Center For Success Discipline pIIanagement

NAML
Not following instructions

DATES OF BEHA OR

Not accepting criticism Not accepting "No"

Swearing/disrespectfu I language voice/tone

Inappropriate gestureVfacial expressions

Being uncooperative with authority


Makes Noises Scuffling/Horseplay VerbaUphysical threats or arguing

Profanity

Talking

ilo

permission

Offtask / daydreaming
Sleeping / head down Refirsing to do class work

Out of

seat

Marking on/in school property Throwing objects Lyrng


Stealing Gum, candy, food or drinks Inappropriate materials
Dress code/shirt untucked-sagging

Jewelry

Qn

dditipnal Comr4ents On Back

Teacher Signature

"

Principal's Disposition:

PrinclpaVAssist Pttclpal

Date
Reviscd 3/6

00

Center For Success Disclpline Management

Not followitrg iGtructions

Not ucpting criticism Not acrcpting '11o"


Swcaring/disrcspcctfu I languagc voicc/tonc Inappropriate Besturcs/facial cxpressions

Bcing uocooperative with au(hority lr{a}cs No iscs

Sculflirg/[Iorseplay Vcrtauphysical tfueats or arguing Profarity


TEIkitr! w/o permission

Off

tark

/ day&caoing

Slccpiry / hcad down

Rsfi$irg to do class work


Out of
sat

Markiry oo/in school propcrty


Tfuowitrg objccts

Lyi"e
Stealhg

Gurq cady, food or drirks


Ioappropriatc materials Drcss codey'shirt untuckcd-sagging

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

FIRST NAME KAREN

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

COURSE T TLE IPRDI

SEM SEM 8 18 EXM GRD


+ +

::
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

402502 3 3502 502 2 8 0000 789502 5 3000 5 0000 02502 78950


0250
8 5000 2 50

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

CLASS RANKING: 045 FUNCT10N CODE: A=ADD B=BACKUP SIJMGRF

DAILY-ATTN:0.0
E=EXIT

ACAD GPA:

0.225 G=GET

TOT GPA:

0.225 N=NEXT F2=ME

LINE I: c=cHANGE D=DROP

F=FORWARD

F HELP

L=LAST

ATE:

: 9:07 4/23/04 TIME:

Center For Success Discipline Management


DATES OF BE A OR NAME:
No t following instructions

Not accepting criticism Not accepting 'TIo"


Swearing/dijrespectfu I language voice/tone Inappropriate gestures/facial expressions

Being uncooperative with authority


Makes Noises

ScufflinglHorseplay
VerbaUphysical threats or arguing

Profanify Talking w/o permission

Offtask / daydreaming
Sleeping / head down

Refruiug to do class work Out of seat

Marking on/in school propcrty


Throwing objects

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

M/1 PE JENT# SEX GRADE TRACK S/E STATUS F 09 oo00202272


D,TE U/L UN) D,TE Eu

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 ::

]1,II T/L TD) PERIOD ATTENEIANCE

,1: :EE LEA

ATE I

MONDAY

TUESDAY

8:52

CENTER FOR SUCCESS GALENA PARKINDEPENDEM SCH00L DIS uCT


13838 WoodfOttS HOustOn.Texas 77015 (713)330 3134

3/

SUSPENSION NOTICE

BEEN SUSPINDED FROM CEMERFOR


SUCCBSSFOR

DAY(S).

sCH00L A

rm DttG TIME OFSUSPENS10N.

5/

F b-24-04

03:071111

lr ufl illlilPvlllt

EClt

HIGHPOINT SCH00L STUDENT REFERRAL CHECKLiST


Securi$ S"cia-t
Nsmber

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.

Attendance ExP:anat10n WaFning Letter

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:

16. DiStrict Bus Stop

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

STU# LAST NAME 2322 NAVARRETE

FIRST NAME KAREN

MI PERMANENT# SEX GRD RNG


0000202272 F

09 0-9

TRK STATUS CRDT O.00 R00M REM 40 6 SPB3 0 2403 5 24 6 5 2 4 6 GGYM 7 TB 4 8 23 2 4

SECI PER S 0747 S 0637 2 S 0390 3 S 308 4 S 23 5 S 0020 6 S 0932 7 S 0977 8 S

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

GALENA PARK INDEPENDENT SCH00L DISTRICT PLACEMENT ORDER

t G
I 2ust

ciI

Student SS#or PE

iS#

is
Horfie [,anguag,

L h

Sp.Ed.:

If yes date of ARD: If yes datc of 504 Mtg.:

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 #.

Rccommcndado s)fOr Acdonl


ISS # Days Expulsion: HHs crc 0

CFS#Days
JJAEP(Tcl

24-
Waiver:

S Placement

ITCm
No

11)

Ycs

Comments:
Parcnt Notification of Action:


Ycs

No

Parcnt Notification of Duc Proccss:

No

NOTE: 5mdCnt',pa /shali


WtItTE COPY: Hcaring Ofliccr

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

CEttR FOR SUCCESS GALENA PARKINDEPENDEW SCH00L DIS uCT .


13838W

dfO HOuStOL Texas 77015 13)330 3134

3
LA

SUSPENS10N NOTICE

Z
DAY(S).

BEENSUSP7NDD F M CNERFOR

succEssron

TIIIIS SIUDENr WILL R3-TO CFS ON:

sCH00L ACHV

I b oTAmND,

OR rARIICIPATE IN ANY

DIJRING TIME OF SUSPENS10N.

Center F'or Success Discipline Management


TES OF BEIIAVIOR

gJL AME:t
Not following instructions Not accepting criticism

Not acceping "No"


Swearing/disrespectfu I language voice,/tone Inappropriate gestureVfacial e4pressions Being uncooperative with authority
Makes Noises

Scuffling/Horseplay
VerbaVphysical threats or arguing Profanity

Talking w/o permission Otrtask / daydreaming


Sleeping / head down

Refirsing to do class work Out of seat

Marking on/in school property


-hrowing objects ng Stealing
Gum, candy, food or

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

Center For Success Discipline Management

NAML n4
Not following instructions Not accepting criticism Not accepting "No"
Swearing/disrespectful language voice/tone Inappropriate gestureVfacial expressions

DATES OF BEHA OR

Being uncooperative with authority


Makes Noises Scuffling/Horseplay VerbaUphysical threats or arguing

Profanity

Talking w/o permission

Offtask/ daydreaming
Sleeping / head down Refusing to do class work

Out of seat

Marking oMn school property


Throwing objects

Lyrng
Stealing

Gum, candy, food or drinks Inappropriate materials


Dress code/shirt untucked-sagging Jewelry Gang related activity

Other.Violat ion",

,/(atz.r- t , ,C U/.1

dditignal Comrpents On Back


Teacher Signature

Principal's Disposition:

PrincipaUAssist. Principal

Date
Rcviscd 3/6/00

Center For Success Discipliue Mauagement


N

_
'l'lo"

OR

Not followiag iostsuctioos Not rccptitrg cridcism

Not acccpting

Swcaring/disrespcctfu I language voicc/tone Inappropriate gcsturcs/facial cxpressions

Bciag ucoopcrativc wi(h authority


Makcs Noiscs

Scufilhg/florseplay
VcrbaUphys ica I threats or arguing

Profaaity

Talking
Off
iask

o permission

/ day&eaming

Slccpiry / hcad dowu Rcfirsing to do class work

Out of scat
Marking on/in school propcrty Throwiog objecs

Lvtue
Stcalfug

Guor, caady, food or driakr


fu .appmpriatc Eatcrials

Drcss codcy'sbirt uutucked-sagging

Iewclry
Catrg rclatcd sctiyity Othcr Yiolations:

Pancipal's DisPosit10n:

PrincipaVAssist.Pdncipal

Date

dM

center For Succ sS Discipline Management

DATES OF BEEA OR
N
:

Not following irutructions Not accepting criticism Not accepting "No"


Swearing/disrespectful language voice/tone Inappropriate gestures/facial expressions Being uncooperative with authorily Makes Noises Scuffling/HorsePlaY VerbaVphysical tlueats or arguing

Profanity Talking w/o permission

Offtask / daYdreaming
Sleeping / head down Rcfusing to do class work Out of seat

Marking on/in school Properry Throwing objects Lyrng


Stealing Gurn, candy, food or drinks Inappropriate materials
Dress code/shirt untucked-sagging

Jewelry
Gang related activity

Other Violations:

-e-1-

<[

PrinCipaVAssist.Principal

RcViSCd 3/6/00

sTu# LAST NAME 2322 NAVARRETE


NO

FIRST NAME KAREN

M/1:

ARK

Sy G E
W/H COMMENTS

CRS ID COURSE TITLE

2
3

4 5 6 7 8 9 0
2 3 4 5 6

402502 3 3502 2 502 8 0000 789502 5 3000 5 0000 02502

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.

CRED O.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50

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

DATE: 4/23/04 TrME: 11 :19:19

Center For Success Discipline Management

OR
N APIE:

41ilTESoFBEIIA

Not following instructions

Not accepting criticism Not accepting "No"


Swearing/disrespectfu I language voice,/tone Inappropriate gestures/facial e:rpressions

Being uncooperatiye with authority


Makes Noises ScuffIing/Horseplay VerbaUphysical threats or arguing

Profanity Talking

do permission

Offtask/ daydreaming
Sleeping / head down

Refusing to do class work

Out of seat

Marking oMn school property


-hrowing objects
ing

Stealing Gum, candy, food or ddnks Inappropriate materials


Dress coddshirt untucked-saggrng

Jewelry Gang related activity Other Violalions:

>'
Teacher Signature

Principal's Disposition:

t a1/Assist.Pttcipal

Date
Revised 3/6/00

sTu# LAST NAME 2322 NAVARRETE


PARE F/GUARDIAN NAME ORT Z OSE/ROSARIO

FIRST NAME KAREN

MIDDLE NAME

PE JEN r# SEX GRD STATUS

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

NO RPT DATE CDE

CDC ACT 000

43 04/06/04

DESCRIPTION 02 TARDIES

WARN

04/06/04 04/06/04 675 04/07/04 / /

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

INCIDE 9/04 44 04/

ACT DT 04/06/04 USER LH DRUGS LEVEL 3 CFS 30

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

sTu# LAST NAME 2322 NAVARRETE PARENT/GUARDIAN NAME ORTIZ JOSE/ROSAR10

FIRST NAME KAREN

0000202272

SEX GRD STATUS F 09

NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 7 3 363-7 9 7 3-962-6 2 ASSERTIVE DISCIPLINE RECORDS

NO RPT-DATE CDE DESCRIPT ON

46 04/23/04

CDC

ACT OOO INCIDENI


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

/LL /CIVE HIGH POINT DMTS: 30 N=NEXT X=RSN F =HELP F2=MENU

FUNCT10N CODE: LINE: A=ADD B=BACK C=CHG D=DROP


ADSCRT

L=LAST

sTU# LAST NAME 2322 NAVARRETE PARENT/GUARDIAN NAME ORTIZ OSE/ROSARIO

FIRST llAME KAREN

MIDDLE NAME

PERMANE rI SEX GRD STATUS 0000202272 F 09

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

ACT OOO INCIDEI{T

RSN

Acr D:r 04/05/04 usER


IINE:
11

LH

FUNCTION CODE: A=ADD B=BACK ADSCRT

C=CHG D=DROP E=END F=FORWD G=GET L=LAST

DMTS: 30 N=NEXT X=RSN F =HELP F2=MENU

DATE: 4/23/04 TIME:

:26:02

sTU# 2322

LAST NAME NAVARRETE

FIRST NAME KAREN

MIDDLE NAME

PERMANENT# SEX GRD STATUS 0000202272 F 09

PARENT/GUARDIAN NAME ORTIZ OSE/ROSAR10

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

03/09/04 03/09/04 675

H 0720

CDC

ACT OOO
CDC

ACT DT 03/08/04 USER I,H INCIDENT FDH ig ot/zq/o+ 02 TARDTES

03/26/04 03/26/04 57s

H 0720

ACT OOO

INCIDENT

RSN

ACT DT

03/24/04
E=END

USER LH

FUNCTION CODE: LINE: A3D B=BACK C=CHG D=DROP


ADSCRT

DMTS: 30 F=FORWD

F =HELP

G=GET

L=LAST

N=NEXT

X=RSN

F2=ME W

DATE: 4/23/04 TrME:

1l-

:26:00

sTu# LAST NAME 2322 NAVARRETE

FIRST NAME KAREN

MIDDLE NAME

PERMANENTI SEX GRD STATUS 0000202272 F 09

PARENT/GUARDIAN NAME ORTIZ OSE/ROSAR10


NO RPT DATE CDE

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

CDC ACT 000

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

03/05/04 03/05/04 675

H 0720

O3/05/O4
E=END

USER LH

A=ADD B=BACK ADSCRT

LINE3=DROP C=CHG

F=FORWD

G=GET

L=LAST

DMTS: 30 N=NEXT X=RSN F =HELP F2=ME U

DATE: 4/23/04 TrME: 11:25:58

Patient info

11

; lnstructions _ nt copy :
1 /
,lime1 8

'
,

,,1

School Release Form

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.

/ab studles *i116,

,rriswei

iy

ippropriate speciatists

and

twittbe

intendedtobecoipleteanddefinitive,medicalcareandtreatment,EKG,s,X+ays,and notified of significant discrePancies'

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

STU# I,AST NAME

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

TCH LOC T]ME

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

FIRST NAME KAREN

MIDDLE NAME

PERMANE FI SEX GRD STATUS 0000202272 F 09

PARENT/GUARDIAN NAME ORTIZ OSE/ROSAR10 NO RPT DATE CDE


CDC ACT 000 RSN INCIDENT 3 0

NO FATHERS WORK MOTHERS WORK COUNSELOR A/C PHONE 3 363-7 9 7 3-962-6 2 7 ASSERTIVE DISCIPLINE RECORDS

/23/04

CDC ACT 000

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 / /

CDC ACT 000 RSN INCIDENT

INCIDE F 33 0 /28/04

RSN

FUNCTION CODE: A=ADD B=BACK ADSCRT DATE:

LINE: c=CHG D=DROP


:25:56

E=END

F=FORWD

G=GET

DMTS: 30 N=NEXT X=RSN F =HELP F2=MENU L=LAST

4/23/04 TIME:

STU# LAST NAME 2322 NAVARRETE


PARENT/GUARDIAN

KAREN

FIRST NAME

MIDDLE

NAME

PERMANEI\IT# SEX GRD STATUS

OOOO2O2272

09

oRTrz,aIosE/RosARro
NO RPT-DATE CDE

NAME

ASSERTIVE DISClPLINE

A/C PHONE-NO FATI{ERS-WORK 7]-3363-71917L3-962-61A2


RECORDS

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

DATE: 4/23/04 TrME: Ll-:25:48

sTu# 2322

LAST NAME NAVARRETE

FIRST NAME KAREN

MIDDLE NAME

PER VttJENTI

o000202272

SEX GRD STATUS 09

ORTIZ OSE/ROSAR 0

PARE F/GUARDIAN NAME

ASSERTIVE DISCIPLINE RECORDS

;]];::]:91' 4: :::YttI

MOTHERS WORK COUNSELOR

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

3.0 / 4/03 679 / 4/03

045

USER SG WARN USER LT F=FORWD

/ 2/03

/ 2/03

675

H 0720

/ 2/03

FUNCT10N CODE: LINE: A=ADD B=BACK C=CHG D=DROP


E=ENEI

G=GET

L=LAST

ADSCRT

DMTS: 30 N=NEXT X=RSN F =HELP F2=MENU

DATE:

4/23/04 TIME:

:25:46

sTu# LAST NAME 2322 NAVARRETE PARENT/GUARDIAN NAME ORTIZ OSE/ROSARIO

FIRST NAME KAREN

MIDDLE NAME

pERMANE # SEX GRD STATUS 09 F 0000202272

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

STU# LAST NAIUE 2322 NAVARRETE


PAREI{T/GUARDTAN

FIRST NAME

KAREN

MIDDLE

NAME

PERMANENT# SEX GRD STATUS OOOO2O2272 F 09 -WORK COIINSELOR

oRTrz,JosE/RosARro

NAME

ASSERTIVE DTSCIPLINE

A/C PHONE-NO FATHERS -WORK MOTHERS 7a3363-71-9L7t3-962-6a1-2


RECORDS

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

ACT DT IO/07/03 USER LH INCIDENT FDH Ls 1-0/!3/03 02 TARDTES

RSN

1'0/17

/03 to/t1 /03 67s H 0720

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

DATE: 4/23/04 TrME: 11 t25t42

sTU

LAST NAME 2322 NAVARRETE

FIRST NAME KAREN

MIDDLE NAME

ENr# SEX GRD STATUS PEm 0000202272 F 09

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

CDC ACT 000 RSN INCIDENT

09/30/03

ACT DT 09/29/03 USER LH 1D BADGE WARN ACT DT 09/30/03 E=END

09/30/03 09/30/03 675

H0720

USER LH F=FORWD

FUNCT10N CODE: LINE: A=ADD B=BACK C=CHG D=DROP


ADSCRT

G=GET

L=LAST

DMTS: 30 N=NEXT X RSN F =HELP F2=MENU

DATE:

4/23/04 TIME: 1

:25:4

STU# LAST NAME 2322 NAVARRETE


PARENT/GUARDIAN NAME ORTIZ OSE/ROSAR 0
770 5

FIRST NAME KAREN

MIDDLE NAME

PERMANENT# 0000202272

SEX GRD STATUS F 09

MAILING ADDRESS

803 NANCY ROSE #

CITY NAME HOUSTON WORK PH /EXTN PH ST


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

BIRTHDAT LOCKER ADV 09/2 /88

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

REV S/0-PEIM S/O LEP

EFIGENIA MATA 45 -3962 CODE: A=ADD B=BKUP C=CHG D=DROP STUCRT

LAURETINO MATA E=END F=FWD G=GET N=NAME CHG P=PRIIT V=V E X=SWTCH F =HELP F2=MENU

STU# I,AST NAME


2322 NAVARRETE
: 11'=`::t,R38

FIRST
KAREN

NAME

MIDDLE

NAME

PERMANE}IT# SEX GRD STATUS ooo0202272 F 09


TTERSIWORK

COUNSELOR

13ME

AS:::T:;: ON

::::.:::I: ::::lis :: DAI HOUR :3 1:'3: : 1:'I] TCH LOC TIME 8/03 09/ 8/p3

N9 ];,1:'I: C:: CDC


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

L=LAST N=NEXttYTttlR:R I F =HELP F2=MEIJU

ADSCRT

DATE:

4/23/04 TIME:

125:39

sTu# LAST NAME 2322 NAVARRETE

FIRST NAME KAREN

MIDDLE NAME

pERMANE rI SEX GRD STATUS 0000202272 F 09

PARENT/GUARDIAN NAME ORTIZ OSE/ROSAR 0

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

NO RPT DATE CDE DESCRIPTION


CDC ACT 000 RSN INCIDENT 5 09/ 0/03 02 CDC 0 -9 0-003 ACT 002 RSN INCIDE r 6 09/ 6/03 04 CDC 0 -9 0-003 ACT 004 RSN INC DENr

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

09/ 0/03 09/ /03

H0720

SAID RAN AWAY FROM HOME


09/ 6/03 09/ 9/03

0800

Dr 09/L6/03

USER ADL

LINE: FUNCT10N CODE: c=CHG D=DROP A=ADD B=BACK ADSCRT


DATE

E=ENEl

F=FORWD

G=GET

L=LAST

DMTS: 30 N=NEXT X=RSN F =HELp F2=ME U

/ 23 /

04

TIME

11 '- 25 :37

:]

LAST NAME NAVARRETE

FIRST NAME KAREN

M/1 PERMANENT# o000202272 MARK C A B C A F B F

SEX F

GRADE 09 W/H COMMENTS G K

CRS ID cOURSE TITLE

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.

CRED O.50 0.50 0.50 0.50 0.50 0.50 0 50 0 50

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 ]

FIRST NAME KAREN

M/1 PE JEN Il+ SEX GRADE TRACK S/E STATUS F 09 0000202272


D,TE

I::[;181E

A`L ::,:],:

T/L TD) P,TE U/L UN

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

A=I'NX B=BUS C=CFS D=DOC E=EXC

I=ISS

M=TST N=NI]R O=OFF S=SUS T=IDY

/ 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

FIRST NAME KAREN

M/1 PE 4ANENT# 0000202272 D,TE U/L UN

SEX GRADE TRACK S/E STATUS F 09


D,TE

]: [;18TE

A`L ::,11,II T/L TD)


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

M=TST N=NI]R o=oFF

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

sTu# LAST NAME 0 ^^^^ ' 2322 NAVARRETE

7AD'N KAREN

FIRST NAME

MIDDLE NAME

0000202272

PERMANENT# SEX GRD STATUS


F 09

;iiil;;Jo;;iiosanro
CDC ACT 000 RSN INCIDENT

PARENT/GUARDIAN

NAIvtE

A/C

ASSERTIVE DISCIPLINE RECORDS

7L3 363-laer 7a3-e62-6LL2

PHONE-NO FATHERS -WORK MOTHERS -WORK COUNSELOR

NoRPT-DATECDEDESCRIPTIoNDISPDAYHoI]RDSP-DATEEND-DATETCHLoCTIME 08s7 / / / / WARN 'J- 08/25/03 02 TARDTES


ACT DT / /

2 08/26/03
RSN

02 TARDIES
ACT

USER LH WARN

0720

CDC

ACT OOO

iucroeur

CPC ACT 000 RSN INCIDENr

308/2g/o302TARDIESDETog/tl/o309/1-1-/030720 -_,- , MISSED DET 9-2-03, XED BY .IVY ACT DT / / USER LH

DT / /

usER LH

:R: :_9]:lENE6=DROP__::]ND__] ]9]]?__9]9[T__lill:T 1_


i

:;: :iu E FI
DMTS: 30

DATE:

4/23/04 TIME:

:25:34

i l

:III

: '1= =

=:i

lntracare Hospital Certificate of Completion


F
/t

F d 54 lP`
7

`:

Assessnrcu.t

$rantefr

{name,

titkJ

Name: KqREN NAVARRETTE Date ofBirth:o921/88

Confidential Student RePort


o3

Student D eEIMS):S16965516
Local Student D:oooo202272

D
1.Bask Undersmnding.

campus: o42 NORTH SHORE MIDDLE


r

District: 101-910 GALENA PARK ISD

Class Croup:LRBANOVSKY F

EMS
2

:Cnde r:TEtDEtE,',',,,,',,,,S.al9gg!g_-Ig!!Eg.g. YES 2 55 3 SPR NG 2003

No

2.Appung ttmwledge or Llte EletnentS.

3.Usin=StratttLs tO Analtte.

4.Applying Cntical hinking SHlis. .

14

TOTAL l'7111114'111

rrir roo

1500 l?00

le00 | rtoo

2300

23)0

CoEEuded Perfom$c.: Sqlc

Score 0f 2{00

Grnde

n" nall l IS LSII: :Mets IIda,dlC Itl enledPMOl'

3
1.Numbe ,Operalons,and
Quandtative Reasoning
Algeb ic Reasoning.

SPRING 2003

2210

YES

2.P tterns,Relatlonships,ond

8
6

10
7

3.Ceometry and Spatial Reasoning 4.Concepts and U8 of Measurement.

2
5

5
8

5.P babl w

and St

stics.

6 Mathematical Processes and Tools.

10
CoDD.Dded Perlom.rce: Sql Score of 2400

TOTAL 111' 11150

SdL SoR

Met SEDdtrd

: CoriEeded PrfbrBlue

I Issues and Eventsin US.History. 2 Ceographic lnnuences on Histo

2 2

6 9
2

3.Econonic and Sodal influences on History.


4 Po ticJ In uences on H to

5
3

5.Cn cal ThinHng SHIs

l$o
TOTAL II ,11: 14,I

tino

19oo | 2loo
20

23oo

2700 2 7_ 'i.

StrDdrrd: Sctb Score of

CooBeDded PerforEucei Sqle Score of 2'100

Document# 574443796-27675

For more inforrnation about the TAKS tests, contact your child's school'

Print# 3 6732-079

353 Castlegory Houston, TX.77049

North Shore SeniorHigh School Choir


February 4,2003

DEAR KAREN NAVARRETE,

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)

Director of Choral Music North Shore High School

C EM 2 E

aaa.a

11:

, .

g,ed 9 esffons are des

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

ies ferlc act

7bese

"

Student's Name Address Grade Personal tn case of amergencY, conbct: Name

SeX______ ge______ ate of Birth


Schooi

Social Secu ty Number

SASI Nulnber

Physician

Phone

RelationshiP,
q

Phone(H)

(1

V)

S dOnl OW tte a m e rye e srde %iS

S arswer

7,or f7 re9 sa"FrCa am us g tte nS f,2

YES
Have you had

NO

medical illness

or iniury since your last

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?

Are you cunently taking any prescription or non-prescription

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?

ilave you ever had a sprain, strain, or swelling afier injury?


Have you broken or ftac'tured any bones or dislocated any ioints?

Have )lou had any other problems with pain


muscles, tendons, bones, or
lf yes, check appropriate

or swelling

in

loi9Pl

Do you get tired more quickly than your friends do during


exercise?

Have you ever had racing

of your heart or

skipped

tr Head tr Neck tl Back

d etbow D HiP E Forearm a Thigh o Knee o Wrist

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

o Hand tr Chest 13 Finger Shoulder D tr UpperArm tr Foot

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

in sports for any heart Problems?

Do vou have any cunent skin problems (for example'


itciing, rashes, acne, warts, fungus, or blisters)?
Have you ever had a head injury or concussion? Have you ever been knocked out' become un@nscious,-or lost your

Hepatitis B Are you under a doctol's care?

ChickenPox

Femalet Onlv:
When was your first menstruel period?

memory?

It yes, how many times?

Wten was your most re@nl menstrual period?


Ho[, much lime do you usually have ftom the stsrt of one
period to the start of another?
Ho,v many periods have you had in the last year?

When was lhe last concussion? Ho$/ severe was each one? (Explain) Have you ever had a seizure?

Do you have ftequent or severe headaches?

Have you ever had numbness or tingling in your arms'


hands, legs, or feet? Have you ever had a stinger, bumer, or pinched nerve? Have you ever become ill from exercising in the heat?

\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.)

Have you ever gotten unexpecledly short


exercise? after acrivM Do you have asthma?

of

breath wilh

Do you cough, s,heeze, or have trouble breathing during or

Do you have seasonal allergies thal require


7o rhe Pa
crlectt any a la W"bb rhlS

medical

tl O
though

SoFTBALL

swtMMtNG & Dlvlt{c

' lo pabpate udenf arbtt

lt is unde,o*, lhat ewn


consent authoile, sarre harmless llr e

nq tE hpil s}hd assumis any respnsibility iid15iiJj}L-i"rgr" "'rtrw'uoluvLvsYvet'q"'-"::::;^-^;;;:--*t'*..u

Fo*clive quipment is vam

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

alhtete,.whenevef n&, in cao an ae6enl o66urc'

the possrbdity of an a@iient str,, ,emains

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

my dnffits to the sbove questbns aG comde and @flecl'

STU# LAST NAME 7392 NAVARRETE PARENT/GUARD AN NAME OSE/ROSARIO

F RST NAME

MIDDLE NAME

KAREN HOME PHONE


7 3-450-

PERMANENT# SEX GRD STATUS 0000202272 F 07


MOTHERS WORK/EXTN 7 3-962-6 2 CELM

ORTIZ

FATHERS woRK/EXTN 878 7 3-962-6 2 S/D 05/3 AMOW PAID

COIINSELOR3 THOMPSON L LINE NO coDE 'WH 7 2 GYM CT


3

STUDENT FEE DISPLAY


AMOtJNT

/02

PAGE
DATE PAID / / / / / / / / / / / / / / / /

oF

DATE

DESCRIPT ON MATH ADVANTAGE CYM CONTRACT

CHARGED 40.50 0.00

4 5
6

7
8

CHARGED 05/30/02 05/30/02 / / / / / / / / / / / /

BALANCE 40.50 0.Oo

' OUTSTANDING FEES

TOTALS

50.50

.00

50.50

l:

J( ^ ffF `

`CX)

KX J e

alL
=

l f

TttXS CERTIFXCATE XS AW ARDED Ti


/

for being P.:A.S.Su top student 2001 20021 s h ool


ye ar

shOwing rnost improved forl g etting tO ciass on time: uesdav9 1 av 28 1 20021

Cer: Li l'icate

of Complel"ion
lhat.:

Ang-e r lt4a nagemer-i t Cl ass

'l'lri:; i:; lo cer:tify

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

THE HOUSE OF REPRESENttATiVES


Represeniolive Senfron:o hompson
prOudly present ihis Certificole 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

having made satisfactory progress in [he required courses

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 '

Harris Coutty Hosplal Dist ct

'lRITT=, 9/11/ A
1

Community Hea:th Program

NON PRESCRIPT:ON PHARMACY ITEMS

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
:

/11/ 1ll 121 0002-O


[ll
lll

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

Antifugal o Olnaftatel Crearn 15 0m Tube

Asp

Aspi in 325 m9 E:teric Coat :abiets 1 00's

in 325 mg Buffered lAsc in)Tablets 1 00'S

[ll

121

0485-8

H 1ll 121
1ll 121

8622 6

i1 t 3 I
8331-6 BO"Lotion 240 rn1 8ottie
]

Autolet Diabetic Test Kit

Beny n Cough SyruP(or gened0 120 ml BOttle


SdeS

Btte

:s

r. (:

[1l

Pl

1923-5
19501_

Dimdapp ttixir(or genenc)120 ml BOttle

111 [ll 1ll [ll [ll lll 111


lll

121 12] 121 121 121 121 121


121

= 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

Munivnamin w rOn Drops 50 rnl Bottle

lll

12]

6303-O

Mylicon Drops 40m

O.6ml(or genenc1 30 m:Bottle


's

lll 121 lll 121 [11_ 121

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

Physician must write number of items ordered as


PhySiCian's

ArrTs{DA3'{cE "TRfEcr AWARD


^WTf KS SIX STCOS\|'D

Of s6/gz

.WOODLA

tD ACRTS TLTjvtTj,tTARy

-74a-..-, Pa-r-rq,
FRANCES RAMSEY, PRINCIPAL

hroy.

8, tgg6

225C m29
KAREN NAVARETE

fIBSf SU^WEfXS Of si/gz


WooDLA rD AcRTs ELTrvtrNfARV
FRANCES RAMSEY,

ST"f

27, tgg6

9b

iZ 9

H N S d V GNV GOO d d X N )OdSS GNV d H V S

T L N HH03

11

11

91 }

ril 11-t

) ti 11111

Jll)l 14d lVc1 2 11 11


.

1 S 1=, 3 :rit4 11 111 11_ JIIti rtu 11

1 331 1 1'1 H JNI =I 1 _11 V 5331lN ] 1 J u[1.17 v 1 H33


'L

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

1111 I C'11. 111 :,1_ l)1 Nl


11 : 1 C111:

13 _4 Hi Ji 1 1
1

SG

[1 I

10

1 :
1

i$.1 Hi tJ

'1 ](1

11 , 7 t 11
l

' Vu ^CIV J 11)= 1111 , 1 =

lC 6 )'

9111

I.l

NC)

1 E lt

117# 113 _nNvl


1 ilJ..1 Jl IVATI 1 11 F tl }11 J. _111 3

{::
'111..

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