Payment Schedule
Optional
Please be sure to make payments according to the age categories indicated for each family member. Thanks!
Please be sure to make payments according to the age categories indicated for each family member. Thanks!
Forward your payment to:
Cousin Gloria Gary
643 North 63rd Street
Phila., Pa. 19151
215-472-7915
Checks and money orders are accepted. Do not send cash. Payment deadline is May 30th 2015. Please duplicate this schedule if you intend to use it for monthly submissions of payments. Thanks!
Details
Elders- 80yrs. & Up!
— $80.00
Adults (21-79 years)
—$140.00
Youth/Young Adult
12-20 yrs.—$80.00
Younger Still 5-11
years —$60.00
Totals:
Assessment Category
and Cost
Name and # of
those attending
Amount
Submitted
Outstanding
Balance
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