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s <br /> ~~~1 ~~~lr~~~~ <br /> old I4 Ir Ti~~~ ~ <br /> ~ Y <br /> 5 tr~~~ Suite ~akl~r~~! A 4~7 <br /> 0!d Republic Titie Co~ Fide N~.: <br /> E~c~o~r ~f~~er~ ~"oday'~ Date: <br /> R~NTAL~TATEM~NT <br /> In order that rents for the property' I any conveying ~y be correctly prorated, I hereby <br /> state that the security Deposits and Rentals, as to amounts and dates to v~hich they are <br /> paid are as ~oilvv~s: <br /> <br /> Apt Monthly Date Paid Date security <br /> ~o. Tenant's Name Rent From Paid To De os~t Ike s Pet <br /> ~ ~ ~ <br /> ~ ~ <br /> { <br /> t <br /> k <br /> 5 <br /> k <br /> { <br /> A <br /> S <br /> s <br /> i <br /> I <br /> t <br /> i <br /> Attach additional pages if ~eede~ <br /> Page i~ o~ 11 <br /> <br />