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					RECEIPT PAYEE NAME: ADDRESS: CITY, ST ZIP CODE: DATE DESCRIPTION PAYER NAME: ADDRESS: CITY, ST ZIP CODE:

NO.

AMOUNT

SUBTOTAL TAX TOTAL

RECEIPT PAYEE NAME: ADDRESS: CITY, ST ZIP CODE: DATE DESCRIPTION PAYER NAME: ADDRESS: CITY, ST ZIP CODE:

NO.

AMOUNT

SUBTOTAL TAX TOTAL

RECEIPT PAYEE NAME: ADDRESS: CITY, ST ZIP CODE: DATE DESCRIPTION PAYER NAME: ADDRESS: CITY, ST ZIP CODE:

NO.

AMOUNT

SUBTOTAL TAX TOTAL


				
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