%PDF-1.4 % 4 0 obj <> endobj xref 4 82 0000000016 00000 n 0000002250 00000 n 0000002325 00000 n 0000002559 00000 n 0000006518 00000 n 0000006646 00000 n 0000006895 00000 n 0000007085 00000 n 0000007370 00000 n 0000007447 00000 n 0000007641 00000 n 0000007930 00000 n 0000008182 00000 n 0000008369 00000 n 0000008652 00000 n 0000008843 00000 n 0000009127 00000 n 0000009298 00000 n 0000009487 00000 n 0000009520 00000 n 0000009610 00000 n 0000010802 00000 n 0000011049 00000 n 0000011236 00000 n 0000011519 00000 n 0000011710 00000 n 0000011994 00000 n 0000012159 00000 n 0000012348 00000 n 0000012381 00000 n 0000012623 00000 n 0000012810 00000 n 0000013093 00000 n 0000013284 00000 n 0000013568 00000 n 0000013729 00000 n 0000013918 00000 n 0000013951 00000 n 0000014201 00000 n 0000014388 00000 n 0000014671 00000 n 0000014862 00000 n 0000015146 00000 n 0000015346 00000 n 0000015587 00000 n 0000015620 00000 n 0000015867 00000 n 0000016057 00000 n 0000016342 00000 n 0000016536 00000 n 0000016825 00000 n 0000017076 00000 n 0000017263 00000 n 0000017546 00000 n 0000017737 00000 n 0000018021 00000 n 0000018210 00000 n 0000018452 00000 n 0000018485 00000 n 0000018730 00000 n 0000018917 00000 n 0000019200 00000 n 0000019391 00000 n 0000019675 00000 n 0000019863 00000 n 0000020040 00000 n 0000020208 00000 n 0000020396 00000 n 0000020429 00000 n 0000020593 00000 n 0000020782 00000 n 0000020815 00000 n 0000021866 00000 n 0000022913 00000 n 0000022940 00000 n 0000022968 00000 n 0000024733 00000 n 0000025787 00000 n 0000025953 00000 n 0000026195 00000 n 0000026428 00000 n 0000001936 00000 n trailer <]/Prev 30545>> startxref 0 %%EOF 85 0 obj <>stream hb``g`` Y8PE#:$P ?-!r\ \ =.܁p9ס >uC^B6> K.r&r qLXĐ`A씃A7o9|]1h:5NHӍ{zy>+B#UN't[|-.P3@ÖE endstream endobj 5 0 obj <> endobj 6 0 obj <>/Font<>>>/Fields[20 0 R 25 0 R 33 0 R 41 0 R 30 0 R 38 0 R 46 0 R 9 0 R 15 0 R 62 0 R 49 0 R 54 0 R 59 0 R 67 0 R 69 0 R 72 0 R]>> endobj 7 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 8 0 obj [9 0 R 15 0 R 20 0 R 25 0 R 30 0 R 33 0 R 38 0 R 41 0 R 46 0 R 49 0 R 54 0 R 59 0 R 62 0 R 67 0 R 69 0 R 72 0 R] endobj 9 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[42.4056 631.239 53.7981 641.998]/Subtype/Widget/T(Vendor Receipt)/Type/Annot/V/Yes>> endobj 10 0 obj <>/Subtype/Form>>stream x3THW0BCC=cK#SC=sSK3T4B)%,j V endstream endobj 11 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= Q |)}ݴN]7b (fH*gK*ܪ <0>@p #[/Qh.E[庻%D[ւ?ҪO;U endstream endobj 12 0 obj <> endobj 13 0 obj <>/Subtype/Form>>stream x337THW0BCC=cK#SC=sSK3T4B)%,jA' endstream endobj 14 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= P F<7۬Rqq.nAP_%d9"\ar%[#?.[dk uD ^~>a_iw w:R5!:(QOI[ԙp^A!R endstream endobj 15 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[65.1907 611.618 73.4187 621.112]/Subtype/Widget/T(Transaction Date)/Type/Annot/V/Yes>> endobj 16 0 obj <>/Subtype/Form>>stream x3THW0B =## K=Kc T4B)UXUf\ e endstream endobj 17 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= @D)Y.{ٽ6(66N,c" Ӽy1#d(,3,/L"pnff{D߸nO5'JЛ$* d > endstream endobj 18 0 obj <>/Subtype/Form>>stream x337THW0B =## K=Kc T4B)UXUw 6 endstream endobj 19 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= A D|Ŕ^mEw`!1L捰i iqQY<05v@¥׺Ż c3^;c\w7(b1QfIetGILGZ}NMo endstream endobj 20 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/MK<<>>/P 7 0 R/Rect[185.445 612.251 410.132 624.909]/Subtype/Widget/T(Transaction Date 1)/Type/Annot/V()>> endobj 21 0 obj <>/Subtype/Form/Type/XObject>>stream x+  endstream endobj 22 0 obj <> endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[65.1907 590.099 73.4187 599.593]/Subtype/Widget/T(Vendor Name)/Type/Annot/V/Yes>> endobj 26 0 obj <>/Subtype/Form>>stream x3THW0B =## K=Kc T4B)UXUf\ e endstream endobj 27 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= @D)Y.{ٽ6(66N,c" Ӽy1#d(,3,/L"pnff{D߸nO5'JЛ$* d > endstream endobj 28 0 obj <>/Subtype/Form>>stream x337THW0B =## K=Kc T4B)UXUw 6 endstream endobj 29 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= A D|Ŕ^mEw`!1L捰i iqQY<05v@¥׺Ż c3^;c\w7(b1QfIetGILGZ}NMo endstream endobj 30 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/MK<<>>/P 7 0 R/Rect[185.445 590.732 410.132 603.39]/Subtype/Widget/T(Vendor Name 1)/Type/Annot/V()>> endobj 31 0 obj <>/Subtype/Form/Type/XObject>>stream x+  endstream endobj 32 0 obj <> endobj 33 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[65.1907 569.212 73.4187 578.706]/Subtype/Widget/T(Amount)/Type/Annot/V/Yes>> endobj 34 0 obj <>/Subtype/Form>>stream x3THW0B =## K=Kc T4B)UXUf\ e endstream endobj 35 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= @D)Y.{ٽ6(66N,c" Ӽy1#d(,3,/L"pnff{D߸nO5'JЛ$* d > endstream endobj 36 0 obj <>/Subtype/Form>>stream x337THW0B =## K=Kc T4B)UXUw 6 endstream endobj 37 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= A D|Ŕ^mEw`!1L捰i iqQY<05v@¥׺Ż c3^;c\w7(b1QfIetGILGZ}NMo endstream endobj 38 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/MK<<>>/P 7 0 R/Rect[185.445 570.478 410.132 583.137]/Subtype/Widget/T(Amount 1)/Type/Annot/V()>> endobj 39 0 obj <>/Subtype/Form/Type/XObject>>stream x+  endstream endobj 40 0 obj <> endobj 41 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[65.1907 548.326 73.4187 557.82]/Subtype/Widget/T(Items Purchased)/Type/Annot/V/Yes>> endobj 42 0 obj <>/Subtype/Form>>stream x3THW0B =## K=Kc T4B)UXUf\ e endstream endobj 43 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= @D)Y.{ٽ6(66N,c" Ӽy1#d(,3,/L"pnff{D߸nO5'JЛ$* d > endstream endobj 44 0 obj <>/Subtype/Form>>stream x337THW0B =## K=Kc T4B)UXUw 6 endstream endobj 45 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= A D|Ŕ^mEw`!1L捰i iqQY<05v@¥׺Ż c3^;c\w7(b1QfIetGILGZ}NMo endstream endobj 46 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/Ff 8392704/MK<>/P 7 0 R/Rect[185.445 476.173 562.665 557.82]/Subtype/Widget/T(Items Purchased Description)/Type/Annot/V()>> endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream x+2Pt0\HP\(P(h 4 iqrU endstream endobj 48 0 obj <> endobj 49 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[42.4056 445.16 53.7981 455.92]/Subtype/Widget/T(Documentation)/Type/Annot/V/Yes>> endobj 50 0 obj <>/Subtype/Form>>stream x3THW0BCC=cK#SC=sSK3T4B)%,j V endstream endobj 51 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= Q |)}ݴN]7b (fH*gK*ܪ <0>@p #[/Qh.E[庻%D[ւ?ҪO;U endstream endobj 52 0 obj <>/Subtype/Form>>stream x337THW0BCC=cK#SC=sSK3T4B)%,jA' endstream endobj 53 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= P F<7۬Rqq.nAP_%d9"\ar%[#?.[dk uD ^~>a_iw w:R5!:(QOI[ԙp^A!R endstream endobj 54 0 obj <>/N<>>>/AS/Yes/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[65.1907 414.147 73.4187 423.641]/Subtype/Widget/T(Documentation A)/Type/Annot/V/Yes>> endobj 55 0 obj <>/Subtype/Form>>stream x3THW0B =## K=Kc T4B)UXUf\ e endstream endobj 56 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= @D)Y.{ٽ6(66N,c" Ӽy1#d(,3,/L"pnff{D߸nO5'JЛ$* d > endstream endobj 57 0 obj <>/Subtype/Form>>stream x337THW0B =## K=Kc T4B)UXUw 6 endstream endobj 58 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= A D|Ŕ^mEw`!1L捰i iqQY<05v@¥׺Ż c3^;c\w7(b1QfIetGILGZ}NMo endstream endobj 59 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/Ff 8392704/MK<>/P 7 0 R/Rect[78.482 319.209 563.931 392.628]/Subtype/Widget/T(Documentation A1)/Type/Annot/V()>> endobj 60 0 obj <>/Subtype/Form/Type/XObject>>stream x+2Pt0TRXR(P(j 5iqrn  endstream endobj 61 0 obj <> endobj 62 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 7 0 R/Rect[67.0895 299.589 75.3174 309.083]/Subtype/Widget/T(Documentation B)/Type/Annot>> endobj 63 0 obj <>/Subtype/Form>>stream x3THW0B =## K=Kc T4B)UXUf\ e endstream endobj 64 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= @D)Y.{ٽ6(66N,c" Ӽy1#d(,3,/L"pnff{D߸nO5'JЛ$* d > endstream endobj 65 0 obj <>/Subtype/Form>>stream x337THW0B =## K=Kc T4B)UXUw 6 endstream endobj 66 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form>>stream x= A D|Ŕ^mEw`!1L捰i iqQY<05v@¥׺Ż c3^;c\w7(b1QfIetGILGZ}NMo endstream endobj 67 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/Ff 8392704/MK<>/P 7 0 R/Rect[78.482 224.271 563.931 297.69]/Subtype/Widget/T(Documentation B1)/Type/Annot/V()>> endobj 68 0 obj <>/Subtype/Form>>stream x3PpW0T(W03c =KCs#=C 3Tb endstream endobj 69 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/MK<<>>/P 7 0 R/Rect[77.8491 197.689 270.889 214.145]/Subtype/Widget/T(Cardholder Name)/Type/Annot/V()>> endobj 70 0 obj <>/Subtype/Form/Type/XObject>>stream x+  endstream endobj 71 0 obj <> endobj 72 0 obj <>/DA(/Helv 9 Tf 0 g)/F 4/FT/Tx/MK<<>>/P 7 0 R/Rect[365.194 197.689 525.323 214.145]/Subtype/Widget/T(Card Number)/Type/Annot/V()>> endobj 73 0 obj <>/Subtype/Form/Type/XObject>>stream x+  endstream endobj 74 0 obj <> endobj 75 0 obj <> endobj 76 0 obj <> endobj 77 0 obj /DeviceRGB endobj 78 0 obj /DeviceGray endobj 79 0 obj <>stream HWMo81]*)R_e(M Gݓ,11;$EJ,yf=a_ H ϓV<2/kqm-RT}3%v\E Q;OgK.{"CK=Iʅ8Kd 1ZF*[s!K%e8YpZ_o?Vwg|Y+tsUgX$/!E)ŽH@h|;bY}Z:VX=8 FEDA?,F4` )6oAhCYP/yvy3t{"FS"dsJ,C](AOejy9% *JnDl Hh°RUH@I4ixs;Ǧ'm{- LB0'lP5 IkQz IE!9}ǰVoHf% bX{ *mxEբ2^c" C.ؗԧc64U4=%c" uhͪt"M9I0 $ӌ /`ǪIѮdx^PRd3C'7!&O"j4IaD!Uش[mü""Vԥ[w,e"2nGaɏ><9B!s |2;\&C4k*~N&IU!5( nnREk(_M*u/#ui,x7PE\eKt%'N׀طCy,Γ(Nۇ?|3@"2TN |3 bBZw.R%xO9V _7^%'6 !Q`4o/f$˄]zh+$}g!BCbs`ui,Rε} Fޡ0iYgrm/@"JJ$d$Uga XBbdyh3{E4]I Nd-0`ωfd\:C#(W*~Eu$&]բhc+ Mz s! !a{} S70>0u=!!V2 "GZӵ+ *f`փjF[93 [=k'S󂟠 "Q@R(6)it흖bkM(¿W9x^mjpR#K[ kqJthg -3v]I}0җ.+yy;\2v +,)7̆mr|/@Jv^rсݗm)i8eNk(`9h[T>^gfϊQ/#6 ļW֋K^qL=Z3f7gO~f1l'bZaXKLd)}gn:7KɍkWr3a:D"j1L aǻ\aj\ZV:> IY*_fbRfIE nœ_RaĒayY} M29##|8ʖ87)#D\֋]c"PfE^ ֓h 9`ɌajXW5T|{қNk@ԭFP(U, H#g͜ȝ]U'+5X# /t\JArßD{j㾊 0} endstream endobj 80 0 obj <> endobj 81 0 obj <> endobj 82 0 obj <> endobj 83 0 obj <> endobj 84 0 obj <> endobj 1 0 obj <> endobj 2 0 obj <>stream Acrobat PDFWriter 5.0 for Windows NT 2002-10-18T11:55:17Z 2025-09-03T11:39:51-05:00 2025-09-03T11:39:51-05:00 Supplemental receipt form - Microsoft Word application/pdf Supplemental receipt form.doc Administrator uuid:f43f430e-d4c7-48f2-8042-614c7db0edbe uuid:a338ff5a-dfc4-4b06-81ae-2a7823ceb1da endstream endobj 3 0 obj <> endobj xref 0 4 0000000000 65535 f 0000026670 00000 n 0000026721 00000 n 0000030302 00000 n trailer <]>> startxref 116 %%EOF