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MONEY ORDER Tracking No.

: -00001-MO
31 December 2008: DATE

Pay to the Order of: for $ .00

Pay: and 00/100 DOLLARS

From Account No.: 123456789


Autograph By: _________________________________
STRAWMAN Authorized Representative
Address
Processor:IRS Technical Support Division
C/O The Treasury UCC Contract Trust Department of the IRS
Department of the Treasury
COPY FOR 1500 Pennsylvania Avenue, NW
Washington, D.C. 20220

RECORDS
Memo:

Cut on line

MONEY ORDER Tracking No.: -00001-MO


31 December 2008: DATE

Pay to the Order of: for $ .00

Pay: and 00/100 DOLLARS

Account No. 123456789


Autograph By: _________________________________
STRAWMAN Authorized Representative
Address
Processor:IRS Technical Support Division
C/O The Treasury UCC Contract Trust Department of the IRS
Department of the Treasury

Original 1500 Pennsylvania Avenue, NW


Washington, D.C. 20220

Memo: