HomeMy WebLinkAboutRECEIPT - 06-00313 - Walgreens - Signit of Rexburg
Depart m-exrpt of Comm u`*Nevelopment
19 E Main St. / Rexburg, ID. 83440
Phone (208) 359-302-0 / Fax (208) 359-3022
Receipt Number- 06,0417
0600313
Sign
Deposit
0600313
Sign
Perm it
Previous Payment History,-:':
Total
$100.00
$75.00
$25.00
Total:
Am ount Paid Permit #
JUN 2 2 2006
Fee
Balance
$0.00
$0.00
gen,pmtrreceipts Page I of 1
CLAIM FORM
VENDOR #
NAME
ADDRESS
CITY, STAT
At.
E9 Zip
v OIL
so
am
AMERICA'S FkMILY c OMNillNf CY
DATA'
FED ID or SS#
TE L E P H 0 N -E
-
CLAIMANT F8
OR HS AGENT S1GN HERE