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