POS 14.97 Fee(s) Total I Total this period year-to-date' Total Overdraft Fee(s) Total Returned Item Fee(s) *As al the first Waxman; pc-nod Oat Deposal January °teach year. RANKAATE I NAME (FIRST ADDRESS INO. STREET) CHANGE OF ADDRESS PLEASE PRINT. USE BLUE OR BLACK BALL POINT PEN. MI LAST $6