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SAVINGS DEPOSIT/WITHDRAWAL/TRANSFER

FORM D

(1)

Local Community Name: ___________________ House Code: ______



Address: _________________________________ Month: ______



City, State, Zip: ___________________________





Source Account Distribution Total $

Date Description Type Number Amount Amount

(2) (3) (4) (5) (6) (7)









1) Identify your Local Community Name, Address, House Code and Month of activity.

2) Enter Date of the deposit/withdrawal/transfer.

3) Enter Description of the transaction.

4) Enter the Source Type. D-Deposit, W-Withdrawal, T-Transfer.

5) Enter Account Number. Refer to (Appendix A) in Central Accounting Manual.

6) Enter Distribution Amount. The total Distribution Amount should equal the Total

$ Amount in (7).

7) Enter Total $ Amount of the transaction.



COMMENTS:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



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