CHECK 
NUMBER 
DATE 
CHECK IN FAVOR OF, OR 
DEPOSIT ON ACCOUNT OF 
OBJECT 
OR 
VOUCHER 
NUMBER 
Amount brought forward, 
/ 1 
1 1 
• * 
j 
Amount forwarded, 
AMOUNT OF 
CHECK 
12 $ 
/ j$u 
211 
CHECK 
PAID 
BALANCE 
^ *5 2 
AMOUNT OF 
DEPOSIT 
0 0 
