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RECEIPT
BE IT KNOWN, that the undersigned
hereby acknowledges receipt of the sum of $______________ paid
by ________________, which payment constitutes ______________
[indicate full or partial] payment of the below described obligation:
______________________________________________
______________________________________________
_____________________________________________
If this is in partial payment of
said obligation, the remaining unpaid balance on this date is
$_____________.
Signed this_____ day of __________________,
20____.
Witnessed:
Witness _______________________________
