AO 41A LEDGER (Rev. 10/89)

OFFICE OR CASE IDENTIFICATION

Fund: G 6855 _ _ G 604700 G Other (Specify)

Local Depository:

Date

(m/d/yyyy)

Description

Received

(Debit)

Disbursed

(Credit)

Balance

(DR - CR)

AO 41A LEDGER (Rev. 10/89)

OFFICE OR CASE IDENTIFICATION

Fund: G 6855 _ _ G 604700 G Other (Specify)

Local Depository:

Date

(m/d/yyyy)

Description

Received

(Debit)

Disbursed

(Credit)

Balance

(DR - CR)