1. Receipt Library Services Section
State Library of North Carolina Department of Cultural Resources Archives/Library Building
Date:
109 E. Jones Street (4641 MAIL SERVICE CENTER)
Raleigh, North Carolina (RALEIGH NC )
Received from:
(Name)
(State Agency or Patron’s Address)
payment in the amount of
(cash/coin/check) for photocopies/computer
printouts/scans/microfilm printouts prepared in
Services
Branch, Library Services Section, State Library of North Carolina.
K:\LSSAdmin\Deposit Forms\RECEIPT.DOC
Received by
Receipt
Library Services Section
State Library of North Carolina Department of Cultural Resources Archives/Library Building
109 E. Jones Street (4641 MAIL SERVICE CENTER)
Raleigh, North Carolina (RALEIGH NC )
Date:
Received from:
(Name)
(State Agency or Patron’s Address)

2. payment in the amount of
(cash/coin/check) for photocopies/computer
printouts/scans/microfilm printouts prepared in
Services
Branch, Library Services Section, State Library of North Carolina.
K:\LSSAdmin\Deposit Forms\RECEIPT.DOC
Received by