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  7.                                      RECEIPT
  8.                                     (Specific)
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  12.                 The undersigned hereby acknowledges the receipt of
  13.         _____________($              ) Dollars from __________________
  14.         in full payment, satisfaction and discharge of the obligation
  15.         dated _____________,19__ which is more particularly described
  16.         as follows:
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  20.                 Signed and sealed this ______day of ______, 19__.
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  24.         ______________________________         _________________________
  25.         Witness
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  29.                                                         Form 129
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