Da Form 1857 - Statement Of Account Page 2

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STATEMENT OF ACCOUNT
MAKE CHECKS PAYABLE TO TREASURER OF US
For use of this form, see AR 37-108; the proponent agency is USAFAC.
(Present or mail this portion of the bill with the payment.)
ACCOUNT NUMBER
FROM:
BILL NUMBER
DATE DUE
BILLING DATE
TO:
DETACH THIS PORTION OF BILL
DATE
DESCRIPTION OF CURRENT CHARGES
AMOUNT
Balance Forward
Current Charges
Taxes
Interest
Penalty
Processing
PAY THIS AMOUNT
2
DA FORM 1857, JUN 1983
EDITION OF 1 AUG 71 IS OBSOLETE
APD LC v2.00
(3 Part)

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