DS-DE 48 (Rev. 08/03)
OFFICE ACCOUNT REPORT
(Section 106.141, F.S.)
(PLEASE TYPE)
Name Office to Which Elected
A
ddress City State Zip Code
Name of Bank
Address City State Zip Code
This report contains __________________________ pages of Deposits and
Disbursements, upon which I have written my initials covering the period o
f
_
_______________________ through _______________________.
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, __________________________________________, certify that this report
is complete, true and correct.
________________________________________________
Signature of Elected Official
X
OFFICE USE ONLY
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