Payment statement AC1-0000000455. Claim identifier 100000005909, service provider 4040088311, payment date 5/11/2026. Category: ON — Home support ongoing — $20.00.
Statement line: Khamarni Nunez, SERV-0001, $20.00 service, $4.09 paid. The difference is the individual contribution deduction. SAH client contribution status: Not created.