|2 West Court Street|
|(Names of owners/proprietors here)|
|(Date, i.e. YYYY-MM-DD)|
|(Type of payment)|
Then, put whatever you want down here! Note that http://local.google.com is sometimes a good and easy place to find times/phone. Better yet, look them up in the phone book, and ask them. Remove the fields you don't fill out — or even better, look up or call them for the missing information!
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