HomeMy WebLinkAboutRECEIPTS - 06-00217 - Back to Health Chiropractic - SignR f :L'c X. I JIR 1
.............. . ............... City of Rexburg
-0285
Departm ant Of COMM L j Development Receipt Number. 06
19 E Main St. / Rexburg, 10. 83440
Phone (208) 359-3020 / Fax (208) 359-3022
0600217
0600217
Sign Permit
Sign Deposit
$25.00
$75.00
Total:
$25.00
$75.00
$1 00.00
MAY - 5 2Q�6
C-ITY OF HX
R-I!��-IFROr"t-21n,
$0.00
$0.00
genpntr-receipts Page I of I
CLAIM FORM
VENDOR #
NAME
ADDRESS
i�c�v i ck � r
.r
CITY, STATE, ZIP }`.(�u1�i,�Yr�i
4'T) 9`�,.i-{✓ I
AMERICA'S F,gMILY COMMUNITY
DATE
FED ID or SS#
TELEPHONE .Far 'L
CLAIMANT PR NIS AGENT SIGN HERE