IL Re Woods Village.<\/p>\n
QUALIFIED ITEMS: PROOF OF CASH PAYMENT(S)<\/p>\n
Date<\/p>\n
Manor Address:<\/p>\n
Telephone No:<\/p>\n
Print Your Name:<\/p>\n
Your Signature:<\/p>\n
If payment for a Qualified ltem was made in cash, please submit a signed, legible document<\/p>\n
from the vendor showing that the work was completed and cash payment was made in full. The<\/p>\n
vendor’s name should be printed under the signature and the signature must be legible. [ attest<\/p>\n
by my signature above, that the items shown below were completed and paid for in cash.<\/p>\n
AMOUNT<\/p>\n
PAID TO<\/p>\n
Kitchen Countertop<\/p>\n
Kitchen Floor<\/p>\n
Master Bath Countertop<\/p>\n
Master Bath Floor<\/p>\n
Guest Bath Countertop<\/p>\n
Guest Bath Floor<\/p>\n
Heat Source<\/p>\n
Skylight<\/p>\n
Smoke Detector<\/p>\n
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\u05d4\u05d5<\/p>\n
Other:<\/p>\n
Od<\/p>\n
Other:<\/p>\n
Notes:<\/p>\n
This document shall be submitted as follows:<\/p>\n
LJ<\/p>\n
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LJ<\/p>\n
\u05d1\u05d0\u05de\u05e6\u05e2\u05d5\u05ea \u05d3\u05d5\u05d0\u05e8<\/p>\n
VMS \u05d1\u05e2"\u05de<\/p>\n
\u05dc\u05d9\u05d3\u05d9: \u05e9\u05d9\u05e8\u05d5\u05ea\u05d9 \u05e0\u05d3\u05dc"\u05df - \u05d4\u05e1\u05d3\u05e8\u05d9 \u05ea\u05d9\u05e7\u05d5\u05e0\u05d9\u05dd<\/p>\n
PO Box 2220, Laguna Woods, CA 92654-2220<\/p>","protected":false},"author":2,"featured_media":0,"template":"","document_category":[1095],"document_type":[53],"class_list":["post-17755","document","type-document","status-publish","hentry","document_category-reimbursement-forms","document_type-other"],"acf":{"document":2945,"resolutions":null,"legacy_id":"","pdf_extracted_text":""},"yoast_head":"\n