IAL FirstBankPR004565 EFTA 00128045 EFTA01670346 THIS FORM IS PROVIDED TO HELP YOU BALANCE YOUR STATEMENT TO VERIFY YOUR CHECKBOOK BALANCE WITH THE E.NOING BALANCE OF THIS STATEMENT FOLLOW TI ILSE INSTRUCTIONS OEPOST5 NOT CREDITED BY THE SAME 3 Dcert.1., rN :rfttid Pr te Ese. 5 DATE ....... ____••_.._ .... •