MS-2011-00475_0004.tif City of Blair 1 Inv
218 S 16th Street Page 1 of 1
Blair, NE 68008
DATE INVOICE #
ArO �lse o1 cx °') Phone: (402) 426 -4191 10/24/2011 2011 -01123
ACCOUNT: Fax: (402) 426 -4195
PAID DATE 10/24/2011
Olson & Stewart Construction Inc.
PO Box 271 PERMIT NUMBER MS- 2011 -00475
Blair NE 68008 1020 S Hwy 30
Phone: 402 426 5785 BC TUS 178, 265 266 14 -18 -11 114 PC 137
Blair, NE 68008 -
Date Status Payment Amount
10124/2011 OriginalDue 115.00
10/24/2011 Paid Check Check 2041 Hold deposit ck 2040 - 50.00 ( -) 115.00
To tal Paid 115.00
1 hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws.
Signature of Contractor or Authorized Agent
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