Charter Thank You 6295399 - Savvy Sassy Moms

Charter Thank You 6295399

CHARTER COMMUNICATIONS * 09/25/12 09:50 1265 JOHN 0 HAMMONS 100 MADISON WI * 4M29 OJW 888-438-2427

-SUBSCRIBER INFORMATION HARRIS FELLMAN STMT BAL:$ 140.97 CUR:$ 140.97 ACCT: 8245100171223239 LAST PAY:$ 130.00 (09/06/12)

PAYMENTS- CASH CHECK* OCit

0.00 0.00 0.00

TOTAL AMT: 0.00 - A C

_ E: E PMENT ACTIVITY

EQPT SERIAL NUMBER ACT E SERIAL NUMBER ACT EQPT SERIAL NUMBER ACT SABCCNZPS RET

By signing b lo I • knowledge and recognize my obligations with respect to the equipment being issued to me, as set forth

on the revers i this pia r g e.- -Ole the section entitled "Customer Acknowledgment of Equipment Responsibility".

C- SIGNATURE -i...) Date i ......._

charter.com 1-888-GET-CHARTER CUSTOMER COPY

Signature_

Platinum Visa Business Card Company Statement

8 TANGLED WEB INC

0 4080 PARADISE RD STE

Company Account Number: 4339 9300 0527 0683

Bank of America

Credit Limit Cash Limit Cash Advance Balance Available Credit

$30,000 Billing Date $6,000 Days in Billing Cycle $0.00 Payment Due Date

$1,630 Minimum Payment Due

06-05-11 31

06-30-11 $613.73

New Balance $28,370.02

Page 1 of 2

COMP

ANGLED WEB INC

339 9300 0527 0683

Company Total

Previous

Balance - Payments Credits Purchases/Other Cash Finance

+ Debits/Fees + Advances + Charges New

= Balance

$28,494.31 $608.90 $0.00 $151.25 $0.00 $333.36 $28,370.02

CARDHOLDER NEW ACTIVITY SUMMARY

Credits Purchases and Cash

Other Debits Advances Total

Activity

I ARRIS M FELLMAN ■ 339 9318 9365 3527

Credit Limit $30,000 $0.00 $151.25 $0.00 $151.25

Customer Service Finance Charges Total Annual Percentage Rate 14.00% Company Account Summary 800.673.1044, 24 hours Average Daily Annual Periodic Previous Balance $28,494.31

Daily Periodic Percentage Finance Payments $608.90

Balance Rate Rate Charge Credits $0.00 Outside the U.S. PURCHASES $25,001.89 0.03354% 12.24% $259.96 Purchases/Other $151.25 509.353.6656, 24 hours CASH $3,565.14 0.06641% 24.24% $73.40 Debits/Other Fees

Cash Advances $0.00 For Lost or Stolen Card: 800.673.1044, 24 hours

Overlimit Fees Late Payment Fees

$0.00 $0.00

Finance Charge $333.36


Send Billing Inquiries to: BANK OF AMERICA PO BOX 982238 EL PASO TX 79998-2238

Please see the reverse side for information about your account. — — — ll L'W ll — — — — — — — — ---- ------- — — — -

Please return coupon with your payment.

Business Card Payment Coupon Check box and indicate address change on reverse.

Company Account No. Payment Due Date Minimum Payment Due New Balance

Please Enter Amount Enclosed

4339 9300 0527 0683 06-30-11 $613.73

$28,370.02

Make check or money order payable to: BUSINESS CARD Mail payment to address below.

116111111 lllll TANGLED WEB INC 4080 PARADISE RD STE 15-357

LAS VEGAS NV 89169-4834

**P0021374

BUSINESS CARD PO BOX 15710 WILMINGTON DE 19886-5710

433993000527068300613 7 3 2837002

1:5499900 & 11:000 3000 5 270 68

1 Platinum Visa Business Card Company Statement

Bank of America

Credit Limit Cash Limit Cash Advance Balance Available Credit

$30,000 Billing Date

$6,000 Days in Billing Cycle

$0.00 Payment Due Date $1,630 Minimum Payment Due

06-05-11 31

06-30-11 $613.73


TANGLED WEB INC 4080 PARADISE RD STE

11 Company Account Number: 4339 9300 0527 0683

Page 2 of 2

COMPANY DETAIL Posting Sale Date Date Category Reference Number Transactions Amount

06-01 05-30 15183204320053100080701 PAYMENT - THANK YOU 608.90 CR 06-03 06-03 PURCHASE *FINANCE CHARGE* 259.96 06-03 06-03 CASH * FINANCE CHARGE * 73.40

CARDHOLDER ACTIVITY

HARRIS M FELLMAN 4339 9318 9365 3527 Credit Limit $30,000 TOTAL ACTIVITY $151.25

Posting Sale Date Date Category Reference Number Transactions Amount

05-30 05-27 24492151147849998602197 PAYPAL *ISAYAHNATHA 402-935-7733 CA 150.00 05-30 05.27 24492791147118000117831 CITY GLENDALE PARKING MET818-5483960 CA 1.25

1111 LICENSE NUMBER

NOTICE OF DELINQUENT RENEWAL 6HNG200

iii 11 I 11 ISD 83VR (REV. 9/2010)

MMOFMIFORN

- -il WMU&II I" OF MOTOR VEHICLES

A Public Service Agency

C030811P01 10479 P20002

`LICENSE NUMBER MAKE 6HNG200 INFIN

VIN JNKCV64E78M111168

DMV USE DUE DATE AMOUNT DUE :

02/08/2011 $600 ,

PNO - Planned Nonoperation 230101 06172316020000 0060000 03910101010000 Change of Address (see back) 00050608000 0000023000 16036999 72 2521111A

For DMV Use Only ,,

Registration or Certification of Planned Nonoperation (PNO) and late payment are due. Our records show that you have not renewed the vehicle's registration or filed a PNO with the $18 filing fee. California law requires all vehicle owners to register or, if the vehicle is not being operated, parked or towed upon a street or highway, to place a nonoperation status on file before the vehicle's registration expiration date. A PNO may be filed with a payment of a late filing fee, up to ninety days after the vehicle expiration date. After ninety days, a PNO cannot be filed.

To file Planned Nonoperational (PNO) status

* Determine PNO eligibility. Vehicle has not been operated (driven, moved, or parked on a street or highway) after the registration expiration date of 02/08/2011 .

• If eligible, check the PNO box and complete the Certification of Nonoperation on the bottom portion of the notice and pay the PNO amount due. Note: PNO is valid until the vehicle is operated.

To Renew the vehicle registration

* Pay the renewal amount due on the bottom portion of this notice.

* Evidence of Liability Insurance is required. Return with payment. See reverse side of notice.

Fees and Tax Information for Renewal

REGISTRATION FEE LICENSE FEE (May be an income tax deduction) WEIGHT FEE (This may reflect an increase authorized by statute effective 1/1/95.) COUNTY/DISTRICT FEES (Your county or district has requested these fees.)

SPECIAL PLATE FEE OWNER RESPONSIBILITY FEE PENALTY FEE SMOG ABATEMENT FEE

$57 $283

$0 $10

$0 $0

$230 $20

Total Late Payment Due Now

PNO * RENEWAL

$218 $600

* PNO Filing is not allowed if postmarked after 05/09/2011 NOTE: Additional penalties will be added after one year.

DETACH AND MAIL WITH CHECK OR MONEY ORDER AND APPROPRIATE FORM(S) DO NOT STAPLE, TAPE OR FOLD

MAKE PAYMENT TO:

11.1 11 111 _ _ 1 _ _ 11111111 1111 11111111 1111 1111111 1111 1111 ..111

NISSAN INFINITI LT LSR FELLMAN HARRIS M LSE 425 S BERKELEY AVE PASADENA CA 91107-5063

DMV RENEWAL P . 0 . BOX 942894 SACRAMENTO CA 94294-0894

11111111iiiIIIIIiIIIIIIIIIIIIII111111111111111111111

2301010617231130200000060000039101010100000005 0608000000002300016031399972

p.1/11 SA4

Membership Rewa de Points As of 04/20/11

58,050

Previous Balance $5,646.72 Payments/Credits -$6,224.12 New Charges +$4,521.90 Fees +$0.00


Days in Billing Period: 30

Pay by Computer open.com/pbc

Customer Care Pay by Phone 1-800-492-8468 1-800-472-9297

See page 2 for additional information.

Account Summary

Customer Care

0

I

Business Platinum Card° TANGLED WEB INC HARRIS M FELLMAN Closing Date 04/20/11

OPEN Account Ending 9-91004

New Balance

$3,944.50

05/05/11 Please Pay By

See page 2 for important information about your account.

io - We no longer charge your account a Foreign Transaction Fee ** All references to the 2.7% foreign transaction fee in your Cardmember Agreement for this account are deleted, effective immediately. And, in Your Agreement for Transferring Funds

Electronically, the following is added after the first sentence of the sixth paragraph:

'However, we do not charge this fee for ATM withdrawals made using cards issued on U.S. Consumer or OPEN Platinum Card or Centurion Card accounts.'

T149 ird we 10

s car' Emott(

5/7

Regus a member of

THE REGUS GROUP NETWORK

Please fold on the perforation below, del

N

t21 Payment Coupon yr-plat-Cr

Do not staple or use paper clips open.com/pbc Payby Phone 1-800-472-9297

Account Ending 9-91004

Enter account number on all documents.

Make check payable to American Express.

N

0

N

0

0

02993 11

05R

TM

3A

004

96

Please Pay By 05/05/11

Amount Due $3,944.50

HARRIS M FELLMAN TANGLED WEB INC 2850 W Horizon Rdg Suite 200 HENDERSON NV 89052

111 1 1 1 11111111 11 11 .11111 111111 11 1 11 1 1 11 1 "11"11 11 111 11 11 1 111 111 AMERICAN EXPRESS BOX 0001 LOS ANGELES CA 90096-8000

Check here if your address or phone number has changed. Note changes on reverse side.

0000349991760979518 000394450000394450 17 rI

p. 3/11 SM OPEN


Business Platinum Card® TANGLED WEB INC HARRIS M FELLMAN Closing Date 04/20/11

Detail 'Indicates posting date

Payments and Credits

Summary

Total

Payments -$5,646.72 Credits

HARRIS M FELLMAN 9-91004 -$577.40 -$6,224.12 Total Payments and Credits

Payments Amount

04/04/11* HARRIS M FELLMAN ONLINE PAYMENT - THANK YOU -$4,671.72

03/28/11* TIMOTHY CENTNER ONLINE PAYMENT - THANK YOU -$475.00

04/01/11* TIMOTHY CENTNER ONLINE PAYMENT - THANK YOU -$500.00

Credits Amount

04/14/11 HARRIS M FELLMAN TICKETMASTER NEW YORK NY

4078393900 MIAMI HEAT 20110414

-$577.40

New Charges

Summary

Total

HARRIS M FELLMAN 9-91004

ANDREA J FELLMAN 9-91012

TIMOTHY CENTN ER 9-91020 Total New Charges

$3,282.58

$24.99

$1,214.33

$4,521.90

Detail

HARRIS M FELLMAN

Card Ending 9-91004

Amount

03/21/11 EXXONMOBIL PASADENA CA

626-795-1546

Description

GAS/SERVICES

$65.65

$3.13

$2.68

$1.35

$2.80

$5.43

$14.95

03/23/11

03/23/11

0

° 03/23/11

O c: 03/23/11

0°' 0 03/23/11

I 03/23/11 tl

AMAZON PAYMENTS 866 -749-7545 WA

SERVICE

AMAZON PAYMENTS 866-749-7545 WA

SERVICE


SERVICE


SERVICE


SERVICE

FREECREDITSCORE.COM IRVINE CA

877-300-2507

Continued on reverse

p. 5/11 SM

OPEN Account Ending 9-91004

Business Platinum Card° TANGLED WEB INC HARRIS M FELLMAN Closing Date 04/20/11

Detail Continued

Amount

poi ANDREA J FELLMAN Card Ending 9-91012

I Amount

04/05/11 MAILCHIMP.COM 0022 ATLANTA GA

678-999-0141 Description

MAILCHIMP.COM

$15.00 I

04/06/11 DROPBOX 0150 SAN FRANCISCO CA

$9.99 888-446-8396 Description

COMPUTER DATA

ri TIMOTHY CENTNER Card Ending 9-91020

Amount

03/21/11 CHEVRON. KANGAROO EXPANDALUS1A AL

0000000000

Description Price

FUEUMISCELLANEOUS $50.03

03/22/11

GITTY UP-N-GO, INC 5ANDALUSA AL

$14.12

3344271925 Description Price

SVC STA, WITH/WITHO $14.12

03/22/11 DOMINO'S 5389 0000053344271100

$46.87

3344271100

FAST FOOD REST.

03/23/11 TERMINIXTELECENTER11800-837-6464 TN $75.00

PEST CONTROL

03/24/11 GITTY UP-N-GO, INC 5ANDALUSA AL $50.01

3344271925

Description Price

AUTOMATED FUEL DISP $50.01

03/24/11 ARBYS7181 ANDALUSIA AL $37.17

FAST FOOD RESTAURANT

03/25/11 Hibbett Sports #571 ANDALUSIA AL $18.35

111-111-1111 Description

SPORTING GOODS

03/25/11 HIBBETT SPORTS #977 ANDALUSIA AL $88.43

334-222-2231

Description

SPORTING GOODS

1141 03/26/11

WAL-MART 1091 ANDALUSIA AL $121.58

GENERAL MERCHANDISE

03/27/11

WINN-DIXIE #0471 08775299466

$81.30

8775299466 Grocery/Pharmacy

$50,0-3

a

— 04/01/11

0

CRM ASP INC SAN FRANCISCO CA $24.95

BUSINESS SVC


p. 7/11 SM OPEN


Business Platinum Card® TANGLED WEB INC HARRIS M FELLMAN Closing Date 04/20/11

2011 Fees and Interest Totals Year-to-Date

Amount

$0.00

$0.00

Total Fees in 2011

Total Interest in 2011

02

996 R

O5R

TM3A

004

96

Ig

Membership Rewards First® Monthly Statement and Program News

MEMBERSHIP

rewards FIRST

p. 9/11

1-800-297-1300 International Collect: 305-816-2799

Total Points Balance

Points Earned this Period

58,050

5,564

Use Points For Everyday Charges Use your Card for everyday purchases like groceries, gas, phone bills and more, then go online and use the points you earned to cover those charges. Learn more at membershiprewards.corn/everydaycharges

Earn 4X Points When You Shop Online Earn points fast by going through bonuspointsmall.com every time you shop online at over 275 retailers.

Did You Know?

Prepared for HARRIS M FELLMAN Account Number 1M82065884

Questions About Your Account?

Account Summary March 1, 2011 - March 31, 2011

Opening Points Balance

Points Earned this Period

Points Used this Period

Reinstated Points and Adjustments

Total Points Balance

Points Earned this Period are pending until charges are paid in full and all your accounts are in good standing. Points Earned this Period may include Bonus Points.

Points Transaction Detail March 1, 2011 - March 31, 2011

Points Earned this Period Points Activity On Eligible Charges

Bonus Points Awarded

Total Points Activity Per Card

Business Platinum XXXX-XXXXX9-91004

4,409 0 4,409

Add'I Business Platinum XXXX-XXXXX9-91012

178 0 178

Addl Business Platinum XXXX-XXXXX9-91020

977 0 977

Total 5,564 0 5,564

Membership Rewards points earned may be transferred or redeemed as long as all enrolled Card accounts are in good standing. Points transferred or redeemed cannot be reversed back into the program. Forfeited points can be reinstated for a fee by calling the number provided below or visiting membershiprewards.com . Terms and Conditions of the Membership Rewards* program apply. For more information, visit membershiprewards.com/terms or call 1-800-297-1300. From overseas, call collect 305-816-2799.

Upgrade Your Sights and Sounds - Save 20% on Bose®, Nikon® and Sony®

m

„yards Save 20% on Bose audio, Nikon cameras and Sony TVs this April when you use Membership Rewards® points.

Visit membershiprewards. com/sightsandsoundsl to use points and save.

(MR Message 5943)

Terms and conditions for the Membership Rewards4 program apply. Visit membershiprewards.com/terms or call 1 -800-AXP-EARN (297 -3276) for more information. Participating partners and available rewards are subject to change without notice.


Offers are made only to Cardmembers who meet certain qualifying criteria. By res • ondin • ou will be disclosing to the merchant that you meet these criteria.

0 0

52,486

+5,564

0

0

58,050

Savings this Billing Period Savings Sinceianuary 2011

0.00 0.00

Ongoing Savings

Save 10% Save 5%

TownePlace SUMS

"Aorno11>

Save 5%

t# 1.800 ,# flOwers...,

Save 5%

SPRInGHILL SUITES 4

Save 5%

CAREY° S .UO4

OPEN Sayings' Summary Prepared For Account Ending

HARRIS M FELLMAN

9-91004 TANGLED WEB INC

Offer Description End Date Transactions Savings Transactions Savings Since

This Period This Period Since Jan 2011 Jan 2011

HERTZ - up to 10% OPEN Savings

Ongoing

$0.00 $0.00 $132.23

$0.00

Ongoing Savings Total

$0.00

$0.00

Grand Totals

$0.00 $0.00

Full terms and conditions for the offers above are available on your Summary of Accounts online. Log on to www.opensavings.com . Your OPEN Savings totals are updated daily.

Other Ways To Save!

Save automatically when you use your Card at these OPEN Savings partners.

Express Ground CctirTran Fed: Fed FedixOffice. Hertz

Save 5% Save 5% Save 5% Save up to 10% Save 5%

OfficelWax. H„Y-AZ T Symantec. A IRON MOUNTAIN' WORK WITH US- hpdirect.com

Save 5% Save 5% Save 3% Save 10% Save 10% on transactions of $100 or more.

COURTYARD

Aarriott

Save 5%

EPSON' EXCEED YOUR VISION

Save 5%

----------'----.. --- ---- ---.. FAIRFIELD Residence

Inz, ,

--_-___Aarnott j.l....- AalI1011 -.

Save 5% Save 5%

Logoujo-ks by 0

Save 5%

BAR NES&NOBLEC Save 5%

Enjoy added savings for your business. Learn more at opensavings.com

O O O

Offers are made only to Cardmembers who meet certain qualifying criteria. By rimilondina you will be disclosing to the merchant that you meet these criteria.

Tax Period

Notice date

March 31, 2009

April 25, 2011

Notice CP523

Employer ID number 95-4875447

Department of the Treasury

IRS Internal Revenue Service Philadelphia, PA 19255-0030

7161 7618 3633 1865 4626

074220.862050.0526.012 2 MB 0.515 1394

II nnI II II IIII I niul ullll lII I iliiIIrri II IIulV I iiIIItilIIIIII

TANGLED WEB INC A NEVADA CORP % HARRIS FELLMAN 2850 W HORIZON RIDGE PKWY STE 200 HENDERSON NV 89052-4395500

To contact us Phone 1-800-829-0115

Page 1 of 4

iii *95487544722 *

Notice of intent to levy

Intent to terminate your Installment Agreement Amount due immediately: $23,376.19

The monthly payment for your installment agreement is overdue. Since we did not receive one or more payments from you as agreed to in your installment agreement, your installment agreement will be terminated on May 25, 2011. In addition, the IRS may seize ("levy") any state tax refund to which you're entitled and apply it to your $23,376.19 in overdue taxes on or after July 24, 2011.

What you need to do immediately

Billing Summary

Amount you owed $17,449.37 Failure-to-pay penalty 4,196.44

Interest charges 1,730.38

Amount due immediately $23,376.19

Pay immediately • Send us the past due amount or we will terminate your installment agreement under

Internal Revenue Code Section 6159(b) and the full amount you owe will be due immediately.

Continued on back...

la IRS

Payment

TANGLED WEB INC Notice CP523 A NEVADA CORP

% HARRIS FELLMAN

2850 W HORIZON RIDGE PKWY STE 200

HENDERSON NV 89052-4395500

• Make your check or money order payable to the United States Treasury.

• Write your Employer ID number (95-4875447), the tax period (2009), and the form number (941) on your payment and any correspondence.

Notice date April 25, 2011 Employer ID number 95 -4875447

Amount due immediately $23,376.19

INTERNAL REVENUE SERVICE

P.O. BOX 80110 CINCINNATI, OH 45280-0010

954875447 OP TANG 01 2 200903 670 00002337619

Notice

Tax Period

Notice date

CP523

March 31, 2009

April 25, 2011

If we don't hear from you—continued • If you don't pay the amount due or call us to make payment arrangements, we can file a Notice of Federal Tax Lien on your oroperty at any time, if we haven't already done so.

• If the lien is in place, you may find it difficult to sell or borrow against your property. The tax lien would also appear on your credit report—which may harm your credit rating—and your creditors would also be publicly notified that the IRS has priority to seize your property.

• If you don't pay your tax debt, we have the right to seize ("levy") your property.

Employer ID number 95 -4875447

Page 3 of 4

Penalties We are required by law to charge any applicable penalties.

Failure-to-pay Description Amount

Total failure-to-pay $4,196.44

When you pay your taxes after the due date, we charge a penalty of 0.5% (reduced to 0.25% on installment agreements) of the unpaid amount due per month, up to 25% of the amount due. Beginning 10 days after we issue this notice, the penalty increases to 1.0% for each month the amount remains unpaid. We count part of a month as a full month. (Internal Revenue Code Section 6651) For a detailed calculation of your penalty charges, call 1-800-829-0115.

Removal or reduction of penalties We understand that circumstances—such as economic hardship, a family member's death, or loss of financial records due to natural disaster—may make it difficult for you to meet your taxpayer responsibility in a timely manner.

If you would like us to consider removing or reducing any of your penalty charges, please do the following: • Identify which penalty charges you would like us to reconsider (e.g., 2005 late filing

penalty). • For each penalty charge, explain why you believe it should be reconsidered.

• Sign your statement, and mail it to us.

We will review your statement and let you know whether we accept your explanation as reasonable cause to reduce or remove the penalty charge(s).

Removal of penalties due to erroneous

written advice from the IRS

If you were penalized based on written advice from the IRS, we will remove the penalty if you meet the following criteria: • If you asked the IRS for written advice on a specific issue • You gave us complete and accurate information

• You received written advice from us

• You relied on our written advice and were penalized based on that advice To request removal of penalties based on erroneous written advice from us, submit a completed Claim for Refund and Request for Abatement (Form 843) to the IRS service center where you filed your tax return. For a copy of the form or to find your IRS service

center, go to www.irs.gov or call 1-800-829-0115.

Continued on back...

Employment

EDD Development Department

EDD Telephone English Spanish Cantonese Mandarin Vietnamese Self-Service TTY (non voice)

Numbers: 1-800-300-5616 1-800-326-8937 1-800-547-3506 1-866-303-0706 1-800-547-2058 1-866-333-4606 1-800 815-9387

State of California

EMPLOYMENT DEVELOPMENT DEPARTMENT APPEAL FORM

If you want to appeal a Department determination, please explain why you disagree and return this form to the Department using the office address listed on the enclosed notice. You have 20 days from the date of the notice to file an appeal. The 20-day period may be extended for good cause. Reasons for filing an appeal after 20 days must be explained and failure to do so may result in closure of your case.

Please note that claimants for Disaster Unemployment Assistance have 60 days to file an appeal. Employers who are appealing the Department's DE 3807 Notice of Determination or Assessment have 30 days to file an appeal.

I disagree with the Department's decision dated .:5 3 I because:

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'R.( L. Fei 5. ---ry Gop-TA-c-7- 71-11. C - L-rt trvitris7V - 1 G. S9+ i - : 0 0 i-D ,k Ai 4-, (Attach an additional sheet if more space is required)

CLAIMANTS: While your appeal is pending, you must continue to file a continued claim form for the period that you want to claim benefits. If you are found eligible, you can be paid only for periods for which you have filed continued claim forms and have met all other eligibility requirements. For more information on appeal hearings, visit www.cuiab.ca.gov/documents/hip english.pdf.

The following information agent of

Do you need a translator?

must be provided by the party filing the appeal (Appellant) or an authorized the party filing e appeal. Signature of the appellant or agent is required.

■ Yes No If yes, please give language and dialect:

Appellant Name: , A-P-e- t .S ..ii-, Li. rrt A4\1 Appellant Telephone No.: (e9 y7- 79Y7

Appellant Fax No.: ( ) - Appellant Cell Phone No.: ?3 6 y qq3 _ soot/

Appellant E-mail Address: .02..fLf yki..4.4.A x.1E) 6tvirki (._ . c.,t -pv) , .

Do you give permission for the California Unemployment Insurance Appeals Board to send confidential information regarding appeal to this e-mail address? 2"-Yes III No

Do you give permission for the California Unemployment Insurance Appeals Board to send confidential information regarding your cell phone number listed above by text message or voice mail so that information may be received sooner? Yes

It2 Appellant Mailing Address. 2-S50 L) I-44-1 2-'6r•A Pg PCi Cti HI fiipif-SoN1 Ai

your

your appeal to ■ No

g 9 o52,. Street No., Apt. No., or P.O. Box City State ZIP Code

Claimant Name: DA '`■.) t 0 1--- AA i 74-5 cz. Employer Account Number: 9S- tig7- 5L,P7 17 (For employer appeal only)

Claimant Social Security Number-2-u-- 4(0 -111z—

Agent Name (If applicable):

Mailing Address: Street No., Apt. No., or P.O. Box City State ZIP Code

Signature Appellant or Agent: Date: i S Z-°( 1

DE 1000M Rev. 5 (11-10) - Version en espanol en el dorso -

Cu fr:7*

Employment EDD Development Department

State of California

THE FIRST PAGE OF THIS DECISION.

C. FILE YOUR APPEAL WITHIN TWENTY (20) DAYS OF THE MAIL DATE OF THIS NOTICE OR NO LATER THAN 05/23/11.

APPEAL INFORMATION:

WHEN YOUR APPEAL IS RECEIVED, YOUR CASE WILL BE REVIEWED. IF THE DECISION REMAINS THE SAME, WE WILL SEND YOUR APPEAL TO THE OFFICE OF APPEALS. IF YOU APPEAL AFTER THE 20 DAYS, YOU MUST INCLUDE THE REASON FOR THE DELAY. THE ADMINISTRATIVE LAW JUDGE WILL DETERMINE WHETHER YOU HAD GOOD CAUSE FOR THE DELAY. IF THE ADMINISTRATIVE LAW JUDGE DETERMINES YOU DID NOT HAVE GOOD CAUSE FOR SUBMITTING YOUR APPEAL LATE, YOUR APPEAL WILL BE DISMISSED.

THE OFFICE OF APPEALS WILL SEND YOU A LETTER WITH THE DATE, PLACE, AND TIME OF YOUR HEARING AND A PAMPHLET EXPLAINING APPEAL HEARING PROCEDURES. AT THE HEARING, THE ADMINISTRATIVE LAW JUDGE WILL LISTEN TO YOU, EXAMINE THE FACTS, AND MAKE A DECISION. YOU MAY HAVE A REPRESENTATIVE OR SOMEONE ELSE HELP YOU.

DE1080 EZ REV. 1 (06-05)

(PAU)

EMPLOYMENT DEVELOPMENT DEPT ORANGE COUNTY ADJUDICATION CTR P.O. BOX 66000 ANAHEIM CA 92816-6000

l----.. Employment EDD Development

Department

State of California

NOTICE OF DETERMINATION

DATE MAILED 05/03/11 BENEFIT YEAR BEGAN 08/01/10

TANGLE WEB 0170 EDD TELEPHONE NUMBERS: 2850 W. HORIZON RIDGE PK 200 ENGLISH 1-800-300-5616 HENDERSON NV 89052 SPANISH 1-800-326-8937

CANTONESE 1-800-547-3506 MANDARIN 1-866-303-0706 VIETNAMESE 1-800-547-2058 TTY 1-800-815-9387

CONCERNING THE UNEMPLOYMENT INSURANCE CLAIM OF:

D L MEASE SSN 222 46 7122

YOU PROVIDED INFORMATION REGARDING THE ELIGIBILITY OF THE CLAIMANT NAMED ABOVE UNDER CALIFORNIA UNEMPLOYMENT INSURANCE CODE (CUIC) SECTION 1253A. WE HAVE CONSIDERED ALL OF THE AVAILABLE FACTS AND REACHED THE CONCLUSION STATED BELOW. PLEASE DO NOT RESUBMIT THE SAME ELIGIBILITY INFORMATION IN REPLY TO ANY FUTURE CLAIMS NOTICES. THIS DECISION IS FINAL UNLESS MODIFIED, RECONSIDERED, OR APPEALED.

YOU HAVE INDICATED THAT THE CLAIMANT WAS NOT AN EMPLOYEE. AFTER CONSIDERING AVAILABLE INFORMATION, THE DEPARTMENT FINDS THAT THE CLAIMANT WAS AN EMPLOYEE AND THAT YOU WERE THE LAST EMPLOYER. YOU HAVE TEN DAYS FROM THE DATE OF THIS NOTICE TO PROVIDE THE DEPARTMENT WITH FACTS CONCERNING THE CLAIMANT'S SEPARATION FROM YOUR EMPLOY.

APPEAL:

YOU HAVE THE RIGHT TO FILE AN APPEAL IF YOU DO NOT AGREE WITH ALL OR PART OF THIS DECISION.

TO APPEAL, YOU MUST DO ALL OF THE FOLLOWING:

A. COMPLETE THE ENCLOSED APPEAL FORM (DE1000M) OR WRITE A LETTER STATING THAT YOU WANT TO APPEAL THIS DECISION. IF YOU WRITE A LETTER TO APPEAL, EXPLAIN WHY YOU DO NOT AGREE WITH THE DEPARTMENT'S DECISION. WRITE THE CLAIMANT'S NAME AND SOCIAL SECURITY NUMBER ON EACH DOCUMENT YOU SUBMIT TO THE DEPARTMENT (TITLE 22, CALIFORNIA CODE OF REGULATIONS, SECTION 5008).

B. MAIL THE DE1000M OR YOUR LETTER TO THE ADDRESS OF THE OFFICE LISTED ON

Charter Thank You 6295399 - Savvy Sassy Moms

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