FORM 72I

STATEMENT OF MONIES DISBURSED

THE KING'S BENCH

Centre

[Title of Proceeding]

MONIES DISBURSED

Amount	Amount

disbursed	disbursed

as expense	as capital

Amount	Date disb.	To whom disb.	Explanation	payment	payment

[List monies disbursed in chronological order of disbursement.]

Sub-totals:

TOTAL AMOUNT OF MONIES DISBURSED: