b OC4S1 HUM RECEIVED 241.71 IN I D€D( [MlleMt ) 965-1000 241.71 (56 DEPOSIT OF 241.71 Primary Sayings w/ 1 PREY VI 12.25 NEW BAL 253.96 WITHORPAAL 141.0e Primary Sayings w/ 1 Driver's License Number PREY BPL 251% NEW BAL 112.% DISBURSAL 141.20 CASH Other!. D. Member's Signature NCUA