HomeMy WebLinkAboutRECEIPT - 06-00169 - Cedar Ridge Animal Hospital - Sign::1..
CRY of Rexburg
Department of Commlopm e nt Recelpt Number-, 06-0195
1Main St, /' Rexburg: ID. 83440
Phone 0 359-3020 1 Fax -3022
Receipt.Date: 04/03/2006 Cas hie r: EM ILYA_
Payer/Payee Na e:
HANSOM E REED ET UX
k f F
Original Fro
Porm Fe e
it Fee. Des r bio
Am ount
Paid
Balance
0600169 Sign Deposit $75.00 $75.00 $0 0 0
0600169 Sign Permit $25.00 $25.00 $0.00
$100-00
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Page I of 1
CLAIM FORM
VENDOR #
NAME
40
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CITY OF
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AMERICA'S FAMILY COMMUNITY
ADDRESS
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CITY, STATE, ZIP
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DATE
FED ID or SS#
ONE cn
CLAIMANT OR HIS AGENT S1GN HERE