Annex C

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Statement of Receipt and Expenditure of Indian Moneys
Revenue Trust Moneys

.....................................First Nation
For the Year Ended .......................

BCR			Receipt and Expenditure of Funds
Date and No. of BCR	Date Funds Released to FN	Purpose for Release of Funds per BCR	Unexpended Prior Years Withdrawals from Trust Funds - Beginning of Year	Amount Received from Trust Funds	Actual Amount Spent	Unexpended Withdrawals from Trust Funds - End of Year