SERVICES INVOICE

TO: West Virginia Division of Culture and History. The Cultural Center. 1900 Kanawha Boulevard, East Charleston, WV 25305-0300. SERVICES DESCRIPTION: AMOUNT INVOICED: MAKE CHECK PAYABLE TO: ADDRESS: F.E.I.N. OR SOCIAL SECURITY NUMBER: SIGNATURE: TITLE: DATE: I certify that the services listed heron has been received and approved for payment. ................
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