Face

No. ________

$ ________

Office of the Board of Trustees of
 Reclamation District No. _________

The Treasurer of ____ County will pay to the order of ____ out of Reclamation District No. ____ fund the sum of ____ dollars ($____) for ____ allowed by the board of trustees of said Reclamation District No. ____.

Dated _____, 19__.

Trustees

Attest:

Secretary

Reverse

When registered this warrant bears interest at the rate of __ percent per year, computed from the date of registration hereof.

This warrant will outlaw and cannot legally be paid four years after date, unless it is payable by its terms at a future date.

Pay to ____ or order ____.

Presented for payment but not paid for want of funds, this ____ day of ____, 19__.

Treasurer of ________ County