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Emitente: _______________________________________________________
(CNPJ/ CPF) n: ________________________________________________
Endereo:
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Cidade: ______________________________ CEP: ________________ Estado:
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Recebemos de: __________________________________________________,

(CPF/CNPJ) n: __________________ estabelecido em: ________________,
na rua ______________________________________, n __________, a
importncia de R$ ______________ (_______________________________), em
(dinheiro
ou
cheque)
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referente
a
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_____________________________, _________ de __________ de ________

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