Office Report (2)
OFFICE USE ONLY
OFFICE ACCOUNT REPORT
(Section 106.141, F.S.)
(PLEASE TYPE)
Name
MAIL
Office to Which Elected iSTR-iCT
f& Be..t
Zip Code
8'!>L{3to
ss
I
State
FL
City
Bo HlbN (;~
Address
'-{Oo AN-'DoVeR Ct.
Name of Bank
13 A N K. Df A Mer i C","-
Address City State
tD5 N. COt'\G>ItES6 Ave,. BO'fNTa-I BeAeH /-L-
Zip Code
J, 3'1 a...1o
This report contains
pages of Deposits and
Of\e....
Disbursements, upon which I have written my initials covering the period of
Ju.I~
II aDoq
through ~T' 3D, !).ooq
$c2/ '1-: 19-
Balance on hand at beginning of reporting period
Deposits during reporting period
Disbursements during reporting period
Balance on hand at end of reporting period
$
I, ~LENE KOSS ,ce'fythatthisreport
;scomplete ;ao;)u~ ;iPh~
" Signature of Elected Official
OS-DE 48 (Rev. 08/03)
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