~.~ ;;~~:~-~~Il+lls,~ <br />Y.: .. •.•5..~ ...~~.. 1Y1~ <br />Ri:: .~~ .;iF: ~. .. ,:F, 4 <br />,.y <br />~ < `~fr <br />H <br />? _ ' ~. ~ i~t ''~~~~~~7i • •n /;?~rin~~ h~ r~ a, ~~ ~~"n}+}S ~,'JF=3' "31~ ~ <br />2'dr_w":Cii~ 1 .1~~,Sr. R"-'~,~;.r if, 7a'R <br />~~ <br />;} <br />N~IIVI~~ QTY ~F E~C~N~ TART ~AT~ <br />Y~ 011 ~l0~ <br />JAB ADDR~ ~ 5~ HIV ~ 4 AVM <br />~P DATE <br />~9~~ 8l~~ <br />~~~~: ~lul~ ~s ~eov~ <br />B1~LIN ~4DDRE ~8~~ ~~~~V~LT BLIJD <br />IT1~ : ~u~l~~ TAT: ~ ZIP: ~~~a~ <br />TT p ~C~iITI ~ ~ <br />^ II~~i~Y ~Y ~ ~~i~~~~~ <br />DATA <br /> <br />~~VI~~ DE~IPTI~~V <br />~°l~ Late fee v~ri~~ ~~ ~~e~ged ~n ac~~unts <br />after 3D ~~rs fast Due <br />r nit r~~~e fir ne t <br />ate~~~e,e,rer r ~~e <br />Thank You For Your Patronage <br />. q.._..... ... ...~ <br />GLIB TDTAL <br />.~,.~.• <br />~.~~~~°~ <br />r <br />~~~~~~ ~~ <br />~~~~~~ ~~ <br />yl O <br />~~~ o~ <br />TDTAL <br />~~~~ ~~ <br />2~~. ~~ <br />TOTAL AMT $285.00 <br />~~ ~~~~ <br />'.~. <br />