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AUTHORIZED SIGNATURE LIST_1_

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                       BANK WIRE INSTRUCTION FORM

Date: _______________

Orange County Treasurer
P.O Box 4515
Santa Ana, CA 92702
Fax# (714) 834-2912
Attn: Melissa Dobbins – (714) 834-2913
      Fund Accounting – (714) 834-2638


Below are the Authorized Bank Wiring Instructions for: _______________________________.
                                                                           (Name)



                                    Bank Wiring Instruction:

    Bank Name:        ______________________________________________________


    Bank Address:    _______________________________________________________


    ABA #            _______________________________________________________


    Account Name:    _______________________________________________________


    Account #        _______________________________________________________




Approved by:        ________________________________
                          (Authorized Signature)

Title               ________________________________


Contact Name        ________________________________


Contact Phone# ________________________________

				
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