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INTEREST ON LAWYERS/ LIMITED PRACTICE OFFICERS TRUST ACCOUNTS (IOLTA)
REMITTANCE REPORT
This is a supplemental page. DO NOT USE WITHOUT FIRST PAGE.
FINANCIAL INSTITUTION INFORMATION
Name: Branch: Financial Institution
IOLTA ACCOUNT INFORMATION:
Attorney/LPO/ FirmAccount NumberAccount BalanceInterestService ChargesAmount of RemittanceTOTALS
SUPPLEMENTAL PAGE
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