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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


Look well to this day. Yesterday is but a dream and tomorrow is only a vision. But today well lived makes every yesterday a dream of happiness and every tomorrow a vision of hope. Look well therefore to this day. | Francis Gray