HomeMy WebLinkAboutRECEIPTS - 06-00030 - Autumn Winds & West Winds - SignCLAIM FORM
VENDOR #
CITY
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AMERICA'S FAMILY COMMUNITY
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ADDRESS �.�n? i �7.n � W.
CITY, STATE, ZIP 1Z-e011La co gi71"IHi�,
DATE H./?z!oL'
FED ID or SS#
TELEPHONE I Il l ' �) O'l'
DESCRIPTION
CODE
AMOUNT
APPROVED
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CLAIMANT OR HIS AGENT SIGN HERE
REXBURG
City of Rexburg
Department of Community Development
Receipt Number. 06-0028
19 E Main St. I Rexburg, ID. 83440
INE
Phone (208) 359.3020I Fax (208) 359-3022
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Receipt Date: 01/18/2006
Cashier:JANELLH
Payer/Payee Name: STONEGATERD(BURG LLC ETAL
Original Fee
Amount
Fe a
Permit#
Fee Description
Amount
Paid Balance
0600030
Sign Deposit
$75.00
$75.00
$0.00
0600030
Sign Permit
$25.00
$25.00
$0.00
Total:
$100.00
Previous Payment History
Receipt# Receipt Date Fee Description Amount Paid Permit#
Payment
Check
Paymen
Method
Number
Amou t
CHECK
9999
$ 100.00
Total $100.00
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