RECEIPT

RECEIPT

TO:    [NAME OF PERSON MAKING PAYMENT]

RE:    [BRIEFLY DESCRIBE TRANSACTION OR CIRCUMSTANCES GIVING RISE TO PAYMENT]

The undersigned hereby acknowledges receipt of payment of the sum of [AMOUNT OF PAYMENT RECEIVED, ex. $15,000.00)].

DATED: [DATE OF DOCUMENT, ex. July 1, 1998]

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Witness                                 Seller Name