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C 8 Schedule 2008-2023
Use form GC-400(A)(6) for that purpose.)
Date
(mm/dd/yyyy)
Check
No.
Payee and Purpose of Payment
Amounts
$
Subtotal, Medical Expenses:
$
(Add pages as required. Check the box at the bottom of the last page of this disbursement category and total the amount of the
category. Include that sum in the total of disbursements on line 8 of the Summary of Account (form GC-400(SUM)/GC-405(SUM)).
The page total to the right is the number of pages in Schedule C.)
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