Form 1 (Through 6) - Transmittal Of Financial Reports And Certification Of Compliance With United States Trustee Operating Requirements Page 6

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MONTHLY CASH STATEMENT
Period Ending:
Cash Activity Analysis (Cash Basis Only):
Case No:
General
Payroll
Tax
Cash Coll. Petty Cash
Acct.
Acct.
Acct.
Acct.
Acct.
A.
Beginning Balance
B.
Receipts
(Attach separate schedule)
C.
Balance Available
(A + B)
D.
Less Disbursements
(Attach separate schedule)
E.
ENDING BALANCE
(C - D)
(PLEASE ATTACH COPIES OF MOST RECENT RECONCILED BANK STATEMENTS FROM EACH ACCOUNT)
General Account:
1. Depository Name & Location
2. Account Number (last 4 digits only)
Payroll Account:
1. Depository Name & Location
2. Account Number (last 4 digits only)
Tax Account:
1. Depository Name & Location
2. Account Number (last 4 digits only)
Other monies on hand (specify type and location) i.e., CD's, bonds, etc.):
Date:
Debtor in Possession
_________________________________________
Joint Debtor in Possession
Form 5

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