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Christmas Valley Realty’s Payment Coupon Lender Use Only

Payer’s Name______Acct # ______Address: ______Date Received: ______City/State/Zip______Amount ______

Due Date: ______Make Checks Payable to: Payment Due ______Jesse Ivy Amount Enclosed ______61537 SE 15th Bend, Oregon 97702 ------

Christmas Valley Realty’s Payment Coupon Lender Use Only

Payer’s Name______Acct # ______Address: ______Date Received: ______City/State/Zip______Amount ______

Due Date: ______Make Checks Payable to: Payment Due ______Jesse Ivy Amount Enclosed ______61537 SE 15th Bend, Oregon 97702

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Christmas Valley Realty’s Payment Coupon Lender Use Only

Payer’s Name______Acct # ______Address: ______Date Received: ______City/State/Zip______Amount ______

Due Date: ______Make Checks Payable to: Payment Due ______Jesse Ivy Amount Enclosed ______61537 SE 15th Bend, Oregon 97702 ------

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