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55995***RECEIPT*** Date: 04/12/13 Receipt: 55995 Quantity Transactions Reference Subtotal 4 Cert. Copies -Marriage 55993 $40.00 Total Paid: $40.00 Notes: Payment Type CASH Name: Derkach, Anton P.O Box 123 Chelsea, NY 12512 Amount Paid By $40.00 Derkach, Anton Clerk ID: JF Internal ID: 55993