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RECEIPT

BE IT KNOWN, that the undersigned hereby acknowledges receipt of the sum of ______________ dollars ($ ) paid by ____________________________________, which payment constitutes partial/complete payment of the below described obligation:

If this is in partial payment of said obligation the remaining unpaid balance on this date is _____________ dollars ($ ).

Signed this_____ day of __________________, 20__.

_______________________________

By:

Warning:

These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.