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�A' nF ^AI ICnPNIA <br />05"c W11 rn <br />DEPARTMENT OF COMMUNITY SERVICES AND DEVELOPMENT <br />A TOTAL QUALITY MANAGEMENT DEPARTMENT <br />Home Energy Assistance Program <br />P.O. Box 1319 <br />Sacramento, CA 95812-1319 AZTACINT 2' <br />(800) 433-4327 (Toll -Free) <br />(916) 321-5318 (TTY/TDD) <br />1996 HEAP DIRECT PAYMENT SUMMARY <br />PLEASE COMPLETE FOR EACH DIRECT PAYMENT BATCH <br />BATCH <br />IDENTIFIER # <br />(ZH-01, ZH-02 ..) <br />(TOP CENTER OF PAGE <br />UNDER THE U71UTY CO. <br />NAME) <br />BATCH DATE, . <br />(TOP LEFT HAND <br />CORNER OF PRINT <br />QuT) <br />- BATCH.* <br />TOTAL <br />($ AMOUNT OF <br />CHECK FROM CSD) <br />TOTAL. : <br />Amouwr TO <br />RETURN <br />RETURN TO CSD - <br />ATTACH CHECIg <br />TOTAL #F <br />RETURNS <br />TOTAL 8 <br />MATCH <br />Z H% L <br />0s12y16)& <br />1-359.09 <br />1a0,V7 <br />� <br />.�33,�� <br />TOTALS <br />COMPLETED BY: L u.'L 1 i Q <br />PHONE: C��=cL✓ '��t )� <br />UTILITY COMPANY: Q011 1. I1�;.�' )111 YU' DATE: T6Cc �'E& <br />PLEASE RETUf3NII S€1Nt!"4fkRYiN;TH PR' C�.fi'S, MAG4RTS Ate?HEC[�{FOR1-+^A7"Ct-i€5 <br />N€ LATER THAI`J 1 Q. DR 'S FOLLO tl4ttiG REC.9PT « om CS.IN ... .: <br />Please returnsummary to: Katherine Coleman, Supervisor/Document Processing <br />HOME ENERGY ASSISTANCE PROGRAM <br />700 N 10th Street <br />Sacramento, California 95814 <br />IF YOU HAVE ANY QUESTIONS ON HOW TO FILL OUT THIS SUMMARY PLEASE CONTACT: <br />Katherine Coleman (916) 324-1419 or Lisa Bell (916) 323-8820 <br />CSD USE ONLY: <br />CK # I I DPU COMP ! TO DP'. I I <br />