Form Wv/raf-3 - Annual, Limited And State Fair Raffle Financial Report Page 3
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4WV/RAF-3
ANNUAL, LIMITED & STATE FAIR RAFFLE FINANCIAL REPORT
rtL179 v 10-Web
Account #:
Name
PLEASE USE BLUE OR BLACK INK ON ALL FORMS
LISTING OF CHECKS PAID OUT OF RAFFLE CHECKING ACCOUNT
USE ADDITIONAL SHEETS IF NECESSARY *PLEASE NOTE: ALL CHECKS PAID OUT OF RAFFLE ACCOUNT
MUST BE LISTED BEFORE RETURN CAN BE ACCEPTED
CHECK
DATE
PAYEE
PURPOSE OF CHECK
DOLLAR
NUMBER
AMOUNT
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Page 3 of 4
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