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<td width="20%" nowrap>Cerfa No 11580 01</td> |
<td width="20%" nowrap>Cerfa No 11580 01</td> |
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<td nowrap> |
<td nowrap> |
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<center> |
<center> |
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<font size="+2">Reçu dons</font> |
<font size="+2">Reçu de dons</font> |
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<br> |
<br> |
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<font size="+1"> |
<font size="+1"> |
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<b>(Article 200-5 du Code Général des Impôts)</b> |
<b>(Article 200-5 du Code Général des Impôts)</b> |
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</td> |
</td> |
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<td width="15%" nowrap> |
<td width="15%" nowrap> |
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<center> |
<center> |
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Numéro d'ordre du reçu<p></p> |
Numéro de référence du reçu<br> |
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<table border="0" cellspacing="0" cellpadding="1" bgcolor="#000000"> |
<table border="0" cellspacing="0" cellpadding="1" bgcolor="#000000"> |
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<tr> |
<tr> |
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<td valign="bottom" align="center"> |
<td valign="bottom" align="center"> |
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<table border="0" bgcolor="#ffffff" cellspacing="0" cellpadding="3"> |
<table border="0" bgcolor="#ffffff" cellspacing="0" cellpadding="3"> |
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<tr> |
<tr> |
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<td width="20" height="20">No:</td> |
<td width="20" height="20">No:</td> |
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<td width="80" height="20" align="right">__REF__ </td> |
<td width="80" height="20" align="center">__REF__ </td> |
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</tr> |
</tr> |
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</table> |
</table> |
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</td> |
</td> |
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__MAIN_INFO_SOCIETE_NOM__<br> |
__MAIN_INFO_SOCIETE_NOM__<br> |
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<b>Adresse :</b><br> |
<b>Adresse :</b><br> |
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__MAIN_INFO_SOCIETE_ADRESSE__<br> |
__MAIN_INFO_SOCIETE_ADRESSE__<br> |
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<b>Code postal</b> __MAIN_INFO_SOCIETE_CP__ <b>Commune</b> __MAIN_INFO_SOCIETE_VILLE__ <br> |
<b>Code postal :</b> __MAIN_INFO_SOCIETE_CP__<br> |
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|
<b>Commune :</b> __MAIN_INFO_SOCIETE_VILLE__<br> |
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</td> |
</td> |
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</tr> |
</tr> |
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</table> |
</table> |
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__DONATOR_NAME__<br> |
__DONATOR_NAME__<br> |
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<b>Adresse :</b><br> |
<b>Adresse :</b><br> |
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__DONATOR_ADDRESS__<br> |
__DONATOR_ADDRESS__<br> |
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<b>Code postal</b> __DONATOR_ZIP__ <b>Commune</b> __DONATOR_TOWN__<br> |
<b>Code postal :</b> __DONATOR_ZIP__<br> |
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|
<b>Commune :</b> __DONATOR_TOWN__<br> |
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</td> |
</td> |
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</tr> |
</tr> |
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</table> |
</table> |
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</td> |
</td> |
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</tr> |
</tr> |
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</table> |
</table> |
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Date du paiement : __DATE__ <br> |
<b>Date du versement</b> : __DATE__ <br> |
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Mode de versement : __PAYMENTMODE_LIB__ <br> |
<b>Mode de versement</b> : __PAYMENTMODE_LIB__ <br> |
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<table width="100%"> |
<table width="100%"> |
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<tr align="center"> |
<tr align="center"> |
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<td valign="top"> </td> |
<td valign="top"> |
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|
<br><br> |
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|
Merci pour votre don. |
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|
|
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|
</td> |
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<td align="right"> |
<td align="right"> |
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<table border="0" cellspacing="0" cellpadding="1" bgcolor="#000000"> |
<table border="0" cellspacing="0" cellpadding="1" bgcolor="#000000"> |
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<tr> |
<tr> |
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<tr> |
<tr> |
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<td width="200" height="100" valign="top"> |
<td width="200" height="100" valign="top"> |
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<center>Date et signature</center> |
<center>Date et signature</center> |
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|
__NOW__ |
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</td> |
</td> |
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</tr> |
</tr> |
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</table> |
</table> |