HomeMy WebLinkAboutRECEIPTS - 06-00031 - Alpine Chalet - SignCLAIM FORM
VENDOR # I
CITY Cyr
REXBURG
AMERICA'S FAMILY COMMUNITY
NAME Y.��l�IA1r( t;V.li\i Z� j-'lc,aii'Iaac .
ADDRESS %.? W.
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DATE H./n cL'
FED ID or SS#
TELEPHONE I (1 ni ` ' 1011 4
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CLAIMANT OR HIS AGENT SIGN HERE
: e REXBURG
City of Rexburg ' V ^ Receipt Number 06-0029
Department of Communuy Development
19 E Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 / Fax (208) 359-3022
Receipt Date:
01/1812006 Cashier:JANELLH Payer/Payee Name: STONEGATERBaRM LLC ETAL
Permit#
Fee Description
Original Fee
Amount
Amount Fe
Paid Galan
0600031
0600031
Sign Deposit
Sign Permit
$75.00
$25.00
$75.00 $0.00
$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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