LEBANON COUNTY ANIMAL RESPONSE TEAM, INC.
ACCIDENT INSURANCE PREMIUM PAYMENT
FEIN #20-4494967
$10.00 Accident Insurance Premium received from ______________________________
on ________________________________, 20___. Payment was made in the form of
cash_____ check_________.
The accident policy of the Lebanon County Animal Response Team, Inc. will cover members for a one year period for all approved activities of the organization including response events, training, meetings, etc.
A receipt was provided to the Lebanon County Animal Response Team, Inc. member.
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LEBANON COUNTY ANIMAL RESPONSE TEAM, INC.
ACCIDENT INSURANCE PREMIUM PAYMENT RECEIPT
FEIN #20-4494967
$10.00 Accident Insurance Premium received from ______________________________
on ________________________________, 20___.
________________________________________________________________________
Signature Lebanon County Animal Response Team, Inc. Rep. Date