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Proof of Payment Cover Sheet PDF (Free Template)

Create a one-page proof of payment cover sheet that summarizes payer, payee, method, and supporting evidence.

Published February 15, 2026

Courts, landlords, and creditors often ask for a clean cover sheet on top of your payment evidence. This free template gives you a summary page with payer/payee details, payment method, and an evidence checklist you can pair with receipts or bank screenshots.

When to use this

  • You need a concise payment summary to attach to receipts, bank statements, or screenshots.
  • A landlord or creditor requested a cover sheet for a disputed or late payment.
  • You want a neutral, court-friendly summary before adding items to an exhibit index or bundle.

How to do it (fast)

  1. List the case or reference, who prepared it, and the date.
  2. Enter the payer, payee, amount, method (cash, Zelle, PayPal, etc.), payment date, and any reference number.
  3. Add notes describing what the payment covers and list every supporting item you will attach.
  4. Download the PDF and stack it on top of your receipts, statements, or screenshots.

Why this helps

  • Keeps all payment facts on one page so reviewers see key details without digging through receipts.
  • Provides an attachment checklist to prove you included the right screenshots and statements.
  • Works as a neutral cover for court bundles, landlord packets, or creditor correspondence.

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Not legal advice. Courts set their own rules. Keep your original records.