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______________ _____, ________.
RENT RECEIPT

 
of:

,

 
(the "Landlord")

 
AND
 
of:

,

 
(the "Tenant")
 
In regard to the located at , (the "Premises").
 
Rent for the month of: ___________________

Rent Amount Due: ___________________

Rent Amount Paid: ___________________

Rent Paid Via:___________________

Invoice Number: ___________________