DEPOSIT SH 1 FIFTH THSFD BANK CHECK a R 7 / dif DEPOSITS MAY NOT BE AVAILABLE FOR --I EMP E varPIDRAval CHECK TOTAL 1 i I 5 hOCITA f VtOk) 1/4sS 1-C- CUSTOMER NAME SUB TOTAL 13 SIGN HERE F CASH RECEIVED LESS CASH a x RECEIVED a ACCOUNT NUMBER FROM OTHER SIDE a * 747 /85372C Checking 0 Savings I:555560477i: • S 0o0 • ODA 747105372ED SS. 000 - 00 Ref #811143686 Thil 8047361 EFTA00272014

CHECKS LIST EACH CHECK ENTER CHECK TOTAL ON OTHER SIDE AMOUNT EFTA00272015