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Receipt APPLICANT 5/12/2005
'I 2!!5 Fifth Street Springfield.' Oregon 97477 541-'/26-3759 Phone RECEIPT #: 5/12/2005 ':".'i..-;"FI:~~I'!.!_? . iti~".'.'..'..'-' !}..:..... '1Ir' . .&~:. ..: .........-. City of Springfield Official Receipt Development Services Department Public Works Department 2200500000000000576 Date: 05(12/2005 11:21:40AM Amount Due 449.00 449.00 151.00 1,786.00 $2,835.00 Amount Paid ~ $492.00 . $1,677.00 $492.00 $174.00 $2,835.00 Amount Due 449.00 449.00 151.00 1,786.00 $2,835.00 Amount Paid $492.00 $1,677.00 , $492.00 . $174.00 . $2,835.00 Amount Due 449.00 449.00 151.00 1,786.00 $2,835.00 Amount Paid $492.00 $1,677.00 $492.00 $174.00 $2,835.00 Amount Due, 449.00 . 449.00 151.00 1,786.00 $2,835.00 Page 1 of2 I , Paym,ents: iype of Paymeut Check . Check oj Check i:':'-> j"CreditCard 'v ~ .~. , . :if: ~1iii- 'I,P Ij ~; ~ t ;.- ; i'~ ';!, fe,,-.! '~ 1- 'i~ " ! f '! ,~ ~::\:.\ - f! r 5/12/2005 RECEr~ #: Paid By WILDlSH SAND & ORA VEL WILDlSH WILDlSH THOMASPOAOE 2200500000000000576 Check Number Received By Batch Number emm 351158 errun 351156 errun 351157 errun 003307 Page 2 of2 Date: 05/12/2005 .n.llthorization Number How Received In Person In Person In Person 003307 In Person Payment Total: 1l:21:41AM Amount Paid $492.00 $1,677.00 $492.00 . $174.00 $2,835.00