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58264
*** RECEIPT*** Date: 07/29/13 Receipt: 58264 Quantity Transactions Reference Subtotal 2 Cert. Copies -Marriage 58263 $20.00 Total Paid: $20.00 Notes: Payment Type CASH Name: Medina, Jorge 73 Mohagen Ave #1 Middletown, NY 10940 Amount Paid By $20.00 Medina, Jorge Clerk ID: JF Internal ID: 58263