RECEIPT
BE IT KNOWN, that the undersigned hereby acknowledges receipt of the sum of $ paid by which payment constitutes payment on account of the following:
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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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Witnessed:
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State Specific Receipt Forms
–For State Specific Receipt Forms you can download in Word format, go to
http://secure.uslegalforms.com/cgi-bin/forms/query.pl?S-T-B-B-receipt