HomeMy WebLinkAboutRECEIPTS - 06-00029 - Somerset Apartments - SignCLAIM FORM
VENDOR # I
CITY G.,
REXBURG
AMERICA'S FAMILY COMMUNITY
NAME �f���l/k'(A �isill5it�1 l�ia.;t� ilLlt1l?.
ADDRESS '����777`Si -7,M \! .
CITY, STATE, ZIP
DATE H.1?z fuL-.
FED ID or SS#
TELEPHONE ] l!A ` '�L'l I
DESCRIPTION
CODE
AMOUNT
APPROVED
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CLAIMANT OR HIS AGENT SIGN HERE
..e REXBURG City of Rexburg �►'
Department of Community Development Receipt Number: 06-0027
19 E Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 / Fax (208) 359-3022
Receipt Date: 01/18/2006 Cashier:JANaLH Payer/Payee Name: STONEaATEREKBl1RG LLC ETAL
Perm it# Fee Description
0600029 Sign Deposit
0600029 Sign Permit
Original Fee Amount
Amount Paid
$75.00
$25.00
Total:
$75.00 $0.00
$25.00 $0.00
$100.00
Previous Payment History
Receipt# Receipt Date Fee Description Amount Paid Permit#�.
Payment
Check Paymen
Method
Number Amou It
0
CHECK
9999 $100.00
Total $100.00
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