Fourth Quarter - 2009
OFFICE USE ONLY
OFFICE ACCOUNT REPORT
(Section 106.141, F.S.)
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Name Office to Which Elected ~
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Address City State Zip Code~
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Name of Bank
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Address City State Zip Code
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This report contains
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pages of Deposits and
Disbursements, upon which I have written my initials covering the period of
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through :3 - /j--/' / cJ
Balance on hand at beginning of reporting period
Deposits during reporting period
Disbursements during reporting period
Balance on hand at end of reporting period
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is complete, true and correct.
, certify that this report
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(/ s~n~t& of Elected Official
OS-DE 48 (Rev. 08/03)
OFFICE ACCOUNT
DISBURSEMENT OR DEPOSIT INFORMATION
(PLEASE TYPE)
AMOUNT
DATE NAME AND ADDRESS PURPOSE
Disbursement Deposit
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ELECTED OrHCIAL{ Iy TOTAL TOTAL
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OS-DE 48A (Rev. 08/03) U