ACIREND'S TR/IC'1"Of2 5~~`F~4ff~~~ <br /> <br /> <br />~~~M~ ~~R <br />N~~IE: iTY ~~' ~U~N~ <br />,JAB ADDRESS: ~4~3 ~~NO~ DR <br />M~R ~~¢~ ~~~~ <br />BILE, TO: <br />NAME: SAME AS ABQVE <br />BILLING A~ORESS: 1820 ROOSEVELT BLVD <br />CITY : ~UGEN~ STATE: QR ZiP; 9740 <br />A~°~N: KRISTf ~~~~~~~ ~1~ ~~~~ ~~~~~ <br />PHONE #: 54'I-682-4827 <br />DATE <br />~~1 ~I~ <br />S~R11~D q~SC~~pT~~]N <br />V~ID# ~D00~~ <br />~°l~ ~t~ fie ~~~ ~~ c~a~ged o~ acou~t~ <br />Ater ~ days Pit ~u <br />n ~~ ~ damage <br />Thank You For Your Patronage <br />IFJV~ICE #1243 <br />~~~~ ~~ <br />~~~ <br />!~ <br />~? ~~~ <br />~ ., ~. <br />~f <br />~~ <br />~~ TOTAL <br />TDTAL <br />~15~.00 <br />~ 5.00 <br />TOTAL AMT $152A0 <br />~~~ <br />c~ 1 ~ ~ 1 ~~-~ ~~ <br />