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POLK COUNTY FARMERS'COOP <br /> AG WEST SUPPLY 104080 <br /> P.O.Box 47•Rickreall,OR 97371 <br /> REFERENCE GROSS DISCOUNT DISC CHK: 104080 <br /> NUMBER DATE AMOUNT PERCENT TAKEN NET PAYABLE <br /> JI98493 090 2-27-15 92 . 14 92 . 14 <br /> RETURNED MERCHANDISE <br /> �jL l <br /> it <br /> DETACH AND RETAIN THIS STATEMENT <br />