ANCE OF THIS STATEMENT, FOLLOW THESE INSTRUCTIONS S DEPOSITS NO1 CREDITED BY THE BANK AGDOI DATE ANOUMT DESOMS rid COO= Of to Bat. DEDUCT E) Chocks OTATOrdng $ EtAt ANC $ TOTAL OMEGAS OUTSTANDING NUMBER AMOUNT TOTAL Cte0(00Cit TC accoot SF:SWIM oaronon dc rKt natty 1) AI ai:Vtipns and oustraBors