CHECKS OUTSTANDING
		(NOT CHARGED TO YOUR ACCOUNT)
		CHECK NUMBER		AMOUNT					MONTH:			YEAR:
	1								ENDING BALANCE SHOWN
	2								ON STATEMENT			$
	3
	4								DEPOSITS NOT CREDITED
	5								IN THIS STATEMENT (IF ANY)			+ $
	6								ADD			+ $
	7											+ $
	8											+ $
	9											+ $
	10											+ $
	11
	12								SUB-TOTAL			$
	13
	14								CHECKS OUTSTANDING
	15								SUBTRACT			- $
	16
	17								BALANCE			$
	18
	19
	20								NOTE:
	21								DIVIDENDS, IF ANY, THAT APPEAR AS A DEPOSIT
	22								ON THIS STATEMENT MUST ALSO BE ENTERED IN
	23								YOUR CHECK REGISTER AS A DEPOSIT, IN ORDER
	24								TO BALANCE.
	25
		TOTAL
	THIS FORM IS PROVIDED TO HELP YOU BALANCE THE CHECK PORTION OF YOUR STATEMENT.