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0126771 EFTA01271071 THIS FORM IS PROVIDED TO HELP YOU BALANCE YOUR STATEMENT T() VERIFY YOUR CI tECKBOOK BALANCE VoTTI I TI•E E N(NNG BALANCE OF TI OS STATEMENT FOtIOVV It IESE IN STRUCTIONS 0.054T8 NOT CRENTED SY TUE BANK S A.X• ie) ~not sad ey MUM+ IXOLICI 41 ~do; Ouds DATE mauw TOTAL