The memorandum of the receipt or disbursement of moneys by a police justice of a village or by a justice of the peace of a town, required by the said statutes in lieu of the issue of a receipt for moneys paid to such a justice or in lieu of the taking of a receipt for moneys disbursed by such a justice, shall be an entry upon the page or pages of the docket upon which are recorded matters in respect to the action or proceeding in relation to which the moneys were received or disbursed, and shall set forth:
N.Y. Comp. Codes R. & Regs. Tit. 2 § 75.1