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6-6003

H-3—Amount Financed Itemization Model Form

Itemization of the Amount Financed of $
  •  $
    Amount given to you directly
  •  $
    Amount paid on your account
Amount paid to others on your behalf
  •  $
    to [public officials] [credit bureau][appraiser][insurance company]
  •  $
    to (name of another creditor)
  •  $
    to (other)
  •  $
    Prepaid finance charge
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