What you have to pay for:

 Item 1           $
 Item 2           $
 Item 3           $
    ...
 Item 11          $
 Item 12          $
 Total purchases  
       Subtotal   $60.33   
       Sales Tax   $6.03 
                  ------   
           Total  $66.36

Where the payment is coming from:

   Amount you owe $66.36
 Mfr.coupons       $8.50-
 Store coupons    $12.75-
 Gift card        $15.00-
 Cash             $10.00-
 Check            $25.00-
                  ------   
      Your change  $4.98

What you have to pay for:

 Benefit 1       $..... National Defense
 Benefit 2       $..... Aviation system
 Benefit 3       $..... Food supply protection
 Benefit 4       $..... Water supply protection
 Benefit 5       $..... Disaster insurance
 Benefit 6       $..... Public Education
    ...
 Benefit 11      $..... Medical insurance
 Benefit 12      $..... Old Age insurance
 Total benefits   

           Total $66.36

Where the payment is coming from:

 Amount you owe    $66.36
 Prior Tax refund   $8.50-
 Medicare tax       14.50-
 Soc.Sec. Tax       19.35-
 Tax withholding   $27.75-
                   ------   
        Refund Due  $3.74 (Your change)