HomeMy WebLinkAboutRECEIPTS - 05-00304 - The Diamond Gallery - Signs�C
-- Jr.City of
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Department of Com m unity De ve l pm e int
19 E. Main St.
P Rexburg,
ID,
$3440
Phone (208)
359-3020 l
Fax
(208) 359-3022
Receipt Number. -0064
05
00304
Sign
Deposit
00304
Sign
Permit
..........
PreviousPayment History
$75.00
$25.00
Total:
L ff Ke ceiptvate-..vee uescriptionAm ount Paid Permit
$0.00
$0.00
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Page 1 of I
CLAIM FORM
VENDOR #
NAME
ADDRESS
CITY, STATE, ZIP
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RAN
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MERtCAS FAMILY COMMUNV FY
DATE ( 0 ('2�.�
FED ID or SS#
TELEPHONE
CLAIMANT OR HIS AGENT SIGN HERE