CHECK 
NUMBER 
DATE 
n 
CHECK IN FAVOR OF, OR 
DEPOSIT ON ACCOUNT OF 
Amount brought forward , 
r 
■ is *? C(Jl i 
i 
OBJECT 
OR 
VOUCHER 
NUMBER 
Ml 
Ifi***'! 
Amount forwarded, 
AMOUNT OF 
CHECK 
2MSL- 
CHECK 
PAID 
BALANCE 
■mrmMMtf 
V 
/ 4 
AMOUNT OF 
DEPOSIT 
