Denomination	Quantity	Subtotal
$100		$0.00
$50		$0.00
$20		$0.00
$10		$0.00
$5		$0.00
$1		$0.00
Quarters ($0.25)		$0.00
Dimes ($0.10)		$0.00
Nickels ($0.05)		$0.00
Pennies ($0.01)		$0.00
Total Cash:		$0.00

Date:
Staff Initials:
Verifier Initials (Optional):