DETAILED LIST OF SUMS HELD IN TRUST
For quarter ended ____________________, 20 __________.
Information concerning my general trust account:
Number attributed by certificate holder to each transaction: ________ ;
Sum held in regard to each transaction: $________ ;
Total sums held in general account: $________ .
Information concerning all my special trust accounts:
Number attributed by certificate holder to each transaction: ________ ;
Sum held in each special account: $________ ;
Total sums held in special accounts: $________ .
Information concerning all my trust accounts:
Total sums held: $________ .
IN WITNESS WHEREOF, I have signed in ____________________ on this __________ day of ____________________, 20 __________.
(certificate number of real estate broker)
(name and address of real estate broker)
______________________________________________________________
Signature of person authorized by real estate broker