005568 EFTA ((1129048 EFTA01272474 THIS FORMS PROVIDED TONNA YOU RAIAIKE YOUR SIATEMENT TO WW1, WITH,' CONOCX PLANE mirk 114 OWING MOHO' OF THIS QATIMENI, ;WON NISI NSfltX TON ADD Tr) Deposits not (foaled By the Sank $ DEDUCT a Owslardibe Checks flutnno• 5 TOTAL IN CASE OF ERROP5 OR QUESTIO