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  • A4V Sample

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    Jason Henry
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    This document appears to be an acceptance of value from an individual in exchange for an exemption from levy. It was signed by an authorized representative on a given date and lists the individual it was paid to as well as who it was acquired from, including an identification number.

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    © Attribution Non-Commercial (BY-NC)

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    This document appears to be an acceptance of value from an individual in exchange for an exemption from levy. It was signed by an authorized representative on a given date and lists the individual it was paid to as well as who it was acquired from, including an identification number.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    29 views1 page

    A4V Sample

    Uploaded by

    Jason Henry
    This document appears to be an acceptance of value from an individual in exchange for an exemption from levy. It was signed by an authorized representative on a given date and lists the individual it was paid to as well as who it was acquired from, including an identification number.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    ACCEPTED FOR VALUE

    Exempt from Levy

    By: ___________________________ Date: ___________


    Authorized Representative

    Paid to: _________________________________________


    Acquired from: JOHN H DOE, #123456789

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