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I30760 EFTA01273030 THIS FORM IS PROVIDED TO HELP YOU BALANCE YOUR STATEMENT TO VERIFY YOUR Cl ECKBOOK BALANCE 14'171 I TI .E E Neirve BALANCE OF TI Ila STATEMENT FOLLOW Ti IESE INSTRUCTIONS Ces0541 NOT CAEOTTED SY TI* BANK A.X• ‘*) tworAs oad ey Mela+ $ IXIXICI LI 0, Miadro Qude DATE ~Nr TOTAL CHEC