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Concrete Wall
Benefit for the Basin Silent Auction Donation Form/Receipt

6510 South Sixth Street #130 Klamath Falls, OR 97603

                                    EIN: 47-1643310

Thank you for your generous support!

Please fill out the form and print for your records. Submit the form. Donation can be dropped off at the Country  Financial office of Gary Cheyne 5031 S 6th Street or we will  contact you to pick it up. Thank you

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