:w� �:� :. . ,. , . .. , u , , -�:-} • . ee a.� e . --
<br /> • . .. . �� � .r 1� - S-. - ' �r_ _ - .
<br /> ...... ., . _ . . . _
<br /> . . , .t� , - ���. .•S,_ `} � - =
<br /> . . ,
<br /> . . ..._ _ ... .. ... . . . '.�., . . . ._— - . . . . . . '"'" _J.. ...— . � . ,-__- --
<br /> . . ��.. _
<br /> � ""�—
<br /> 1'� t _
<br /> • , .. �.-
<br /> ._.........a:._..,._.. j`,,, , .� __
<br /> [w��po� a` �y �,a�y, pg ,{ .i
<br /> tU11M7�J ��,p�,'�,/ �����������RO�� �����P� MMn�V��51� �`Yi������ y�amw�4�:S l►'�'� �� � -'."•,i--_-_-..`_--_- .
<br /> ... ... • �j � �� t� __
<br /> pATE _t�;?.�`t'.� �lm. 12 4 3 3 0 � �� � = _
<br /> . ^ � �^ .. ,:��:-
<br /> . , , ��.�.��'`'��� � �r W4RK TICK�T N�.����� ,, .•
<br /> ACGY,NO.._.���.. — _ � .,,��_ , �����A� ' _ ._. . .._. ._
<br /> - -- - -. - '� -- --_ __ .
<br /> � ' --.
<br /> . . — SOL�?T4 ' ? "` ,,t �s't.a.f ..-, ..._.._SAC,5��.Nf�. , -
<br /> "7;� .��.. ��._, - -
<br /> , � ADDRESS .__.._....._��`�y�����_�.`� �` - .� ____...�._ E � -
<br /> � � . ,.�. � .,�� .
<br /> CITY ._.,..__._._� _.._.�_-�!`.,�..,�,k. STAT�� ZIP CODE _...,. . , ' ' ,
<br /> � ' r� • . Cd1SH..... .., � ❑ CNARGE,EXISTING ACCQtdIdT . ,, � .
<br /> SALE AMOUNY...... .... .... ... ... . QP (�i CHARGE,NEW ACCOUNT...AUTPdQflI?.�D__/_._../..— ��
<br /> 'Blll, NfXT�bll.l L� ' � �
<br /> . . , QWN('AYMENT...REQ..�, �� ��...�MT.Pp.,,�.r _Cl1STOMF.R DESIR@Q MANTHLY PAYM6NT AMAIdNT•»=��� � i
<br /> ACCT. sroaE CC�ST AMQUNT AF SAI� I�, • '
<br /> QUANTITY STOCK q�CT. �H,� ��,��� ,. .
<br /> �ssuEn aEio Hn NQ, � ITf:MS i" N�. Na. uNU �ou� q,a«
<br /> �
<br /> ,�:.'�'r�!�.,�`'x�� • � �
<br /> i
<br /> ..�.? � ..'�L�� ' 1..,�. 1" ( ,
<br /> . , ,,G,?,� �C,,,��a.-S�' � �,'� �� l ...
<br /> ...laT-u. _ _ -. �
<br /> / '
<br /> •____.. ry' . _.
<br /> t.
<br /> _ • t.�d ,.�,. _ • ^ � ��C` ... Uy j
<br /> ;
<br /> _...�._. ,...__:- ; . .. . .... _;_
<br /> SUMMARY OF STORES ACGQUNTS SUB�QTAI. OZ ,
<br /> OEN•LED STORES � .
<br /> NQ. ACCT.NO. ITEM AMQUNT '
<br /> STATE TAX
<br /> EXCISE TAX
<br /> CITY TAX �
<br /> YOl'Al____,_�
<br /> SUMM�ARY QF R�VENUE ACCOUNT9
<br /> tiEN�IED ITEM ITEMTA%ESA55ESSE0 EXEMPTCODE
<br /> NO, AMQUNT STATB BxGIS@ CITY OiNfiN S X C P
<br /> �� e o �, 4: 5'��
<br /> / G' ���,
<br /> � e� O
<br /> TOl'AI.S
<br /> .i G' ' 'e�T O
<br /> �tUS►atN�R SIC�idAiiiRE �'4�G'�.----- "� ;7 aRlaEroat c::r .
<br /> A Kl�tll INpyGE� aow�,ono'�on�w�v'�rc�uoi a cusr . �
<br /> �
<br /> �
<br /> �....1_ _ _
<br />
|