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STATEMENT OF RECEIPT
Amount: ________________________________________
Paid to: ________________________________________
________________________________________
Paid by: ________________________________________
For (item/service) ________________________________________
________________________________________
Name of program ________________________________________
______________________________________ ______________
Signature of Recipient Date
______________________________________
Printed Name of Recipient
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To think is easy. To act is difficult. To act as one thinks is the most difficult. | Johann Wolfgang Von Goeth