Date

Received From
Amount
For Payment of
From to Paid by [ ] Cash
[ ] Check No.
[42] [ ] Money Order
Received By
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Date
Received From
Amount
For Payment of
From to Paid by [ ] Cash
{42} [ ] Check No.
[ ] Money Order
Received By
Receipt Template by Vertex42.com
Date
Received From
Amount
For Payment of
From to Paid by [ ] Cash
{42} [ ] Check No.
[ ] Money Order
Received By
Receipt Template by Vertex42.com
RECEIPT No.
Balance Due
Balance Due
Account Amt
This Payment
Account Amt
This Payment
Amount
RECEIPT
Amount
No.
RECEIPT No.
Amount
Account Amt
This Payment
Balance Due
Dollars
Dollars
Dollars
$
$
$