MS-2011-00469_0003.tif City of Blair P aid Inv
218 S 16th Street Page 1 of 1
Blair, NE 68008
t a'
DATE INVOICE #
ise of 0 ' Phone: (402) 426 -4191 10/21/2011 2011 -01120
ACCOUNT: Fax: (402) 426 -4195
PAID DATE 10/21/2011
Robinson Construction
1210 H St PERMIT NUMBER MS -2011- 00469
TEKAMAH NE 68061
1642 Nebraska St
Phone: 402 808 4103 BC LOT 8 _PT OF VAC ST BLK 10 114 PC 9
Blair, NE 68008
Date Status Payment Amount
10/21/2011 OriginalDue 65.00
10/21/2011 Paid Check Check #1393 Receipt No 29836 ( -) 65.00
� Total P a id 65.00
1 hereby certify that 1 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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