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PAYMENT TYPE & AMOUNT /"1/~~- ~J/;j .-e:::::~ "':'J d~" ,,~~ Y&<:07; .;3.p:' . CASH CHECK'....!...' .. M.a. ~ .:/ .'?--........ -:-""7F;n.."c:::::::.'~':i7;;":f./.. , i..-- AUTHORIZED SIGNATURE E.F.T c.c./I3.~. OTHER ..MltilAL" '''~'RM' ;~"o~-:.aiiU((A~V'" '''1~.7f: N2 2380 .::;.?::;~) ~~:-, $ . - ~. .C/.- ~.< "~ DOLLARS --roo