HomeMy WebLinkAboutRECEIPT - 05-00138 - Purrington Plaza - SignFn' C)r
City of Rexburg
Department of Community Development
19 E. Main St. l Rexburg, 1D. 83440
done (248) 359-3020 /Fax (208} 359-3022
Receipt ipt Numb r: 100000000421
Permit #
0500138
0500138
dee Descriptian
Sign Permit
Sign Deposit
Tran Original Fee Am ount
Code amount Paid
01-322.20 $25.00 $25-00
01-322.20 $75.00
Total: $100.00
Previous Pa ent History
YM
Receipt # Receipt Date Fee
Description
n- ald Pe- rm ifft
Payor a nt
Method
FEC
No. '_ 20627
fID HO gUSlAFBs popMS - 1-80+-6,3 ,1458
Check
Number
2122
REC'D B
Total
Payment
Am oun#
$100.00
56227
Fe e
Balance
Rage 1 of 1
CLAIM FORM
VENDOR
NAME
ADDRESS
CITY, STATEJ ZIP i
qe�1�
)DA
CITE . �F
RExBuRG
AMERICAS FAMILY COMMUNITY
lor'st
. � ym-
FED ID or S OR-#
TELEPHONE
i
CLAIMANT OR HIS AGENT SIGN MERE