Advance: Prior Advance Balance: $ month This Advance' $ ST" • er) Less: Receipts' $ -01. Funds Returned and/ or Cash on Hand' $ Amount to be Heirnburted'S 27. Document No.cc i c i ?(i‘2 a ittc, i tt . . •,---- i. . i :9-,4 5 , ,. , k t 28, Draft No: 29. Date: c /` Shaded areas for draft o