HomeMy WebLinkAboutRECEIPT - 08-00468 - American Family Insurance - SignS�tx�G T_
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REXBURG
CitYof Rexburg
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p rtment Of Community Dove lmen
19 E, Main St. � Rexburg, ID. 83440
Phone (208) .-3020 / Fax (208) 359-3024
Receipt dumber: -0576
Receipt Date: 019/26/2008 Cashier: ELAINE
P. r/ Paye a Name: HI L L M AN ZAC H
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'Perm it # Parcel Fee Description
0800468 RPFiRCB1034 Perm if -Electrical
0800468 RPRRXB1 034 Sign Deposit
0800468 RRRRJCB'i 034 Sign Permit
Previous Payment History
Receipt # Receipt Date Fee Description `
Paym e nt Check Paym e n
Method Num herAm��
CHECK 999
$140.00
Total $140.00
genpmtrreceipts
Original Fee
Amount
Amount
Pail
Fe e
In
$4Q.00
$40.00 $0.00
$75.04
$75.00 $U.00
$2.'5.D0
_ $25.00 $0.00
Total:
$140.04
Arnaurifi Paid Permit
Page 1 of i
CLAIM FORM
VENDOR #
VENDOR NAME
2nd LINE NAME
w
FAml
- CITY, STATE, ZIP
501
DATE
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Amefica-s' Family Co rnmuniiy
FED ID or SS#
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Circle
1099 CODE:
CLAIMANT 0
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CorporationProduct
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Normal 1099 Rent
HIS AGENT SIGN HERE
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