HomeMy WebLinkAboutRECEIPTS - 06-00072 - Heart Mind & Soul - SignAMR**
r
T Y 0 Z
IJ6 RF,XRG
City of Rexburg
Department of Community Development
19 E. Main St.
!Rexburg,
ID.
83440
Phone (208)
359-3D201
Fax
(208) 359-3022
Receipt Number 06-0092
. .. . ........... ...
'Weemipt Date: 02/1512006 Paye raye e Nam e SIGNATURE SIGNS, LLC
.. . ...........
fir_=..
Original Fee AmoLunt Fe
Permit Fee Description Amount Paid Balance,
. ............. ........ __ I
0600072
0600072
Receipt-#
Payment
Method
CHECK
Sign Deposit
Sign Perm it
Previous Payment History
$75.00
$25.00
Total:
Receapt Date Fee Description Amount Paid P e r m
Check Pm e n
r
Number Am ou I
4*V*j
Totai
$100.00
$0.00
$0.00
genpmtrreceipts Page 1 of 1
CLAIM FORM
NAME
ADDRESS
CITY, STATE, ZIP � tuV t�
t
rt
0
C'yTY OF
AMERICA'S FAMILY COMMUNITY
r
rI �Y-fv
DATE
FED ID or SS#
TELEPHONE
CLAIMANT HIS AGENT SIGN