RECEIPT No. ____________

Date: _________________

Amount Received: $ _______________	[   ] Cash
[   ] Check, No. ____________
[   ] Money Order, No. ____________

For: ____________________________________________________________________________

Money Received by: _______________________________________________________________

RECEIPT No. ____________

Date: _________________

Amount Received: $ _______________	[   ] Cash
[   ] Check, No. ____________
[   ] Money Order, No. ____________

For: ____________________________________________________________________________

Money Received by: _______________________________________________________________

RECEIPT No. ____________

Date: _________________

Amount Received: $ _______________	[   ] Cash
[   ] Check, No. ____________
[   ] Money Order, No. ____________

For: ____________________________________________________________________________

Money Received by: _______________________________________________________________