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Acknowledgment Of Account Balance
ACKNOWLEDGMENT OF ACCOUNT BALANCE
[I/We] agree that [I/we] are currently responsible and liable for the amount of $[amount owed] dollars.
Payable to:
[name of payee]
After reviewing the account information and [my/our] records [I/we] agree that there are no existing credits or setoffs that have not been credited to my account.
This debt is true and payable.
Signature Signature
Date Date