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'i I <br />i <br />I i <br />O1-06057-0~ <br />28825 Hopis Lane . <br />Revenue Ad'ustments Revenue Splits <br />J <br />F ' r~~ x~c 4 i 4 \x~.~ ;,A ~ fr~kr.;Jf~..~."r~%~%r.~ ~ ~ ~/a~~ <br />Original Charge $9,98.21 <br />Revised Charge $0.00 3 <br />Refund Amount $9,918.2 $9,084.1 $898.D4 <br />y s' ~ s, <br />.Original Charge $1,184.75 <br />Revised Charge $0.00 f <br />Refund Amount $1, ~8D.15 $988.92 $99.83 <br />0. n Original Charge $14.00 <br />Revised Charge $0.44 No Split <br />Refund Amount $9D.DD <br />\n ~4.''".cti~:am;..~:~~.'t'J~~.~ ~~ft~i~~ ~ ~ ~ /.~rrx,'.'~~'l rb~ i <br />Original Charge.. $.551.95 <br />:.Revised Charge $55?.95 N0 Spilt <br />Refund Amount $D.Dq <br />Tofa~ Refun~f Amount 9, G8.96 <br />F <br />.Page 2 of Z <br />a <br />. . . . . . . . . . . . . . . . . . . . . . . . . . <br />