DECHARGE

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DECHARGE

Je soussigné, Mr / Mme…………………………………………………………………….

C.N.I N°……………………………………………… du………………………………….…

Délivré par…………………………………………………………………………………….

Reconnaît avoir reçu la somme de………………………………………………………

………………………………………………………………………………………………..

…………………………………………………………………………………………………

…..

Pour :

…………………………………………………………………………………………………

……………………………………………………………………………………………..

Paris le…………………………….….

Bénéficiaire

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