TDHS                                                                                                                    PAGE: 1
PREPARED FOR: TDHS                                    REFUND ACTIVITY REPORT
RUN: 05/04/2011 02:49 PM                            FOR: WEDNESDAY 05/04/2011                                  REPORT NUMBER: FIN009

                        BENEFIT      EBT
        SUB     BENEFIT AVAILABILITY CASE      SS NUMBER/               BENEFIT
PROGRAM PROGRAM MONTH   DATE         NUMBER    CASE NAME                NUMBER            AMOUNT BALANCE   TIME
------- ------- ------- ------------ --------- ------------------------ -------------- --------- --------- -------------------
FS      PAFS    05/2011 05/04/2011   555444108 555-77-8892              DM2600074           1.88    975.88 05/04/2011 12:08:24
                                               BETH SAMPLECASE

                            ACCESSIBLE   TOTAL:             COUNT:       1    AMOUNT:       1.88
                            BENEFIT      TOTAL:             COUNT:       1    AMOUNT:       1.88
                            SUBPROGRAM   TOTAL:             COUNT:       1    AMOUNT:       1.88

                                         TOTAL:             COUNT:       1    AMOUNT:       1.88


                                             ------------ END OF REPORT ------------