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This is a form letter of receipt of money. The form letter provided here is simply a sample of what the actual form letter looks like.


BE IT KNOWN, that the undersigned hereby acknowledges

receipt of the sum of ____________________ (dollars), $______________

paid by ____________________________________

which payment constitutes ______________________________ 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________.



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