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DATE: __________________________

ACKNOWLEDGMENT RECEIPT
I _____________________________________, hereby acknowledge that I received the amount
_____________________________________________________________________________
________________________________as payment for ________________________________
____________________________________________________________________________
_____________________________
Signature over printed name

______________________________
________________

DATE: __________________________
ACKNOWLEDGMENT RECEIPT
I _____________________________________, hereby acknowledge that I received the amount
____________________________________________________________________________
________________________________as payment for ________________________________
____________________________________________________________________________
_____________________________
Signature over printed name

______________________________
________________

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