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# Date Due Amount Due Amount Paid Date Paid Receipt # Balance
****YOU WERE CHARGED $100 IN LATE FEES PER MONTH FOR THE MONTHS YOU HAVE NOT PAID AND YOU WERE CHARGED
$50 FOR THE ONE MONTH YOU MADE A PARTIAL PAYMENT.
_____________________________ ______________________________
Landlord/Manager Signature Tenant Signature
# Date Due Amount Due Amount Paid Date Paid Receipt # Balance
2
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