Comptroller Report Form

House:

Client first name

Vice President Name: 

Text field

Acting Comptroller Name: 

Text field

Date:

Date

___________________________________________________________________________________________________________________

 **If There Is No Member For Slot, Place 0 in Balance Slot. (i.e Only 9 House Members, Slots 10,11,12,13 place 0 as balance)**

Member 1:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

Member 2:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

 

 Member 3:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

 

 Member 4:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

 

 Member 5:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

 

 Member 6:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

 Member 7:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

 Member 8:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

Member 9:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

Member 10:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

Member 11:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

Member 12:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field

_____________________________________________________

Member 13:

Text field

Amount Of Last Payment (Amount Paid)

Text field

Date Of Last Payment

Text field

Balance:

If House Member Has Paid More Than Owed Add +
If House Member Owes Money Put -
If House Member Has No Negative Or Positive Balance Put 0

Text field Text field