Disbursement Voucher

Date:December 19, 1995
Pages:1

FLAG

Church of Scientology

FLAG SERVICE ORGANIZATION, INC.

P.O. Box 31751, Tampa, FL 33631-3751 USA

(813) XXX-XXXX

DISBURSEMENT VOUCHER

Name and Address

AMSOUTH BANK OF FLORIDA
DV# MN 100166
Date 19-Dec-1995
Weekending Date 21-Dec-1995

Telephone (813) XXX-XXXX

Item Description Unit Price Quantity Amount
AMSOUTH BANK OF FLORIDA

1. REFUND/REPAYMENT

Category: 429500000

(REPAYMENTS)



Refund/Repayment regarding

LISA MCPHERSON
0.00 0 5773.00

[handwritten: ] money (Cashiers check) going to mother, Fanny McPherson, who resp. for Estate of Lisa McPherson<

Bank Account MAIN Check # 96742 Total Amount 5,773.00

1994 CSFSO All Rights Reserved. The FSO Corporate logo, The Flag logo, SCIENTOLOGY and FLAG are trademarks and service marks owned by Religious Technology Center and are used with its permission. Printed in USA


AMSOUTH BANK OF FLORIDA

OFFICIAL CHECK

Purchaser: Flag Service Org., Inc.

December 19, 1995

$ 5,773.00

Pay to the order of:

Fannie McPherson<

FSO 00016