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["Eigenbeleg"]
[]
["Nr.","_________________"]
[]
["Betrag","_________________"]
[]
["⃝ Privateinlage","⃝ Privatentnahme","⃝ Bankeinzahlung ","⃝ Bankabhebung"]
[]
["⃝ Sonstiges: _____________________________________________________________________"]
[]
[]
["_________________________________________________________________________________"]
["Datum",null,null,"Unterschrift"]