1239 Adams Strf vnn—
BILL TO: DARREL METZLER
1239 .ADAMS ST
BLAIR NE 68008
Make all checks payable to CITY OF BLAIR
Please return the portion below with your payment.
REMITTANCE
DARREL METZLER 139
Invoice #
1567
Date Due
2/05 /2011
Amount Due
$ 85.00
Amount Enclosed
$
Remit to:
Invoice #: 1567
Invoice Date: 1/06/2011
Payment Due: 2/05/2011
City of Blair
218 SOUTH 16 ST
BLAIR, NE 68008
Phone: 402 - 426 -4191
Fax: 402 - 426 -4195
OFFICE USE: `229
CHECK NO.
RECEIPT NO.