========== TRANSACTION RECORD ==========
GERMED LTD

NEW HYDE PARK, NY
United States
WWW.GERVETUSA.COM

TYPE: Purchase

ACCT: Visa                   $ 65.59 USD

CARDHOLDER NAME : Lee B Smith Mon County Hlth De
CARD NUMBER     : ############5035
DATE/TIME       : 15 Jun 21 10:50:43
REFERENCE #     : 003 0673000 M
AUTHOR. #       : 905105
TRANS. REF.     : GV-1623768643

    Approved - Thank You 100


Please retain this copy for your records.

Cardholder will pay above amount to
card issuer pursuant to cardholder
agreement.
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