HomeMy WebLinkAboutRECEIPT - 06-00457 - Valley Wide - SignCLAIM FORM
VENDOR # I
CI-%IW OF
REXBURG
AMFRICAS FAMILY COMMUNITY
NAME DA c 0PG
ADDRESS 2�1%Ib, �W?4 /UL$U �IIGt i n VtPIA)1�(
CITY, STATE, ZIP
DATE 1 / j_D I07
FED ID or SS#
TELEPHONE
i
F
CLAIMANT lb AGENT SIGN HERE
f ' Rr:XBURG �.�o✓ '+e.B
�., City of Rexburg
Department of Community Development Receipt Number: 06-0624
19 E Main St. / Rexburg, iD. 83440
Phone (208) 359-3020 / Fax (208) 359-3022
:ipt irate: 0911812006 Cashier: EMILYA Payer/Payee Name: Rod.Jones
Original Fee Amount Fee
nit # Parcel Fee Description Amount Paid Balance
0600457 RPRVLYW00: Sign Deposit
0600457 RPRVLYW00: Sign Permit
$75.00 $75.00 $0.00
$25.00 $25.00 $0.00
Total: $100.00
Previous Paytn'ent H'sto
Re ce ipt # Re ce 1pt Date Fes De s.criotlon Amount Paid Permit #
Payment Check Paym e n
Method Number Amoun
CHECK 0994 $ 100.00
Total $100.00
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