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RECEIPT FOR RENT MONEY

On ______________________ (date), ___________________________________ (tenant name)

paid $________________________ in:

G CASH

G CHECK NO. _____________

G MONEY ORDER NO. _______________

for rent on _____________________________________ (address). The tenant still owes

$ ______________________ (balance due after payment).

Money Received By: ______________________________________ (Landlord signature)

______________________________________ (print name)