| 
		Q#15 BREAKOUT 0581-0268 4-2020 | 
		
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		| REGS | 
		REASON | 
		PREVIOUS | 
		NEW | 
		DIFFERENCE | 
		TYPE OF CHANGE | 
	
	
		| 1214.41 | 
		Background Statement (No form) (AD-755) added by mistake in 2017 | 
		12.00 | 
		0.00 | 
		-12.00 | 
		Adj. | 
	
	
		| 1214.71 | 
		Record Keeping | 
		6227.50 | 
		3750.00 | 
		-2477.50 | 
		Adj. | 
	
	
		| 1214.53 | 
		Application for Exemption   (XMAS-AE) | 
		2298.00 | 
		125.00 | 
		-2173.00 | 
		Adj. | 
	
	
		| 1214.52 | 
		Domestic Sales Report       (XMAS-SD) | 
		0.00 | 
		1500.00 | 
		1500.00 | 
		Adj. | 
	
	
		| 1214.52 | 
		Importer Sales Report (XMAS-SI) | 
		1555.00 | 
		250.00 | 
		-1305.00 | 
		Adj. | 
	
	
		| 1214.41 | 
		Nomination Form (XMAS-NF | 
		10.00 | 
		7.50 | 
		-2.50 | 
		Adj. | 
	
	
		| 1214.41 | 
		Background Statement (No form) | 
		10.00 | 
		7.50 | 
		-2.50 | 
		Adj. | 
	
	
		| 1214.105 | 
		Referendum Ballot (XMAS-RB) | 
		114.21 | 
		105.00 | 
		-9.21 | 
		Adj. | 
	
	
		| 1214.53 | 
		Application for Reimbursement (XMAS-RF) | 
		9.25 | 
		7.50 | 
		-1.75 | 
		Adj. | 
	
	
		| 1214.54 | 
		Application for Refund (XMAS-AR) | 
		162.50 | 
		15.00 | 
		-147.50 | 
		Adj. | 
	
	
		| 1214.50 | 
		Donation Form (XMAS-DF) | 
		0.00 | 
		37.50 | 
		37.50 | 
		Adj. | 
	
	
		| TOTAL | 
		SLIGHT DIFFERENCE DUE TO ROCIS ROUNDING.  | 
		10398.46 | 
		5805.00 | 
		-4593.46 | 
		
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		TOTAL | 
		 20,796.92  | 
		 11,610.00  | 
		-9,186.92 | 
		
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