SH 1
DEPOSIT
FIFTH THSFD BANK CHECK a
7 / dif DEPOSITS MAY NOT BE AVAILABLE FOR --I
R I EMP E varPIDRAval CHECK TOTAL
1 i 5 hOCITA f
CUSTOMER NAME
VtOk) /14sS 1-C- FROM OTHER SIDE a
SUB TOTAL a
13 x
SIGN HERE F CASH RECEIVED
ACCOUNT NUMBER
LESS CASH
RECEIVED a
•
* 747 /85372C S 0o0
•
Checking ODA 747105372ED
0 Savings SS. 000 - 00
Ref #811143686 Thil 8047361
I:555560477i:
EFTA00272014
EFTA00272015
CHECKS
LIST EACH AMOUNT
CHECK
ENTER CHECK
TOTAL ON
OTHER SIDE