Form Aoc-E-204 - Affidavit Of Collection, Disbursement And Distribution 1998 Page 2

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BALANCE DISTRIBUTED AS FOLLOWS
AMOUNT
$
Must Agree With
(
)
TOTAL
$
Balance on Front
Signature Of Collector
SWORN AND SUBSCRIBED TO BEFORE ME
Date
Signature
Name And Address Of Collector
Deputy CSC
Assistant CSC
Clerk Of Superior Court
Notary
Date Commission Expires
SEAL
AOC-E-204, Side Two, Rev. 5/98
1998 Administrative Office of the Courts

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