AC-2011-00543_0005.tif I
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City of Blair aid Invoice �
218 S 16th Street Page 1 of 1
Blair, NE 68008
DATE INVOICE #
AIO MIse °t ae°\`,�a Phone: (402) 426 -4191
12/1512011 2011 -01228
Fax: (402) 426 -4195
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PAID DATE 12/15/2011
ACCOUNT:
Morton Buildings, Inc.
PO Box 177 PERMIT NUMBER AC- 2011 -00543
PO Box 177 14512 Cord P16
Onawa IA 51040 TL 19 33 -19 -11 15B PC 12 2.5 AC
Phone: 712-423-2757 Blair, NE 68008
Date Status Payment Amount
12/15/2011 Odgina]Due 841.00
12/15/2011 Paid Check Receipt #30188 Check #1444 ( -) 841.00
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Tota P 841.00
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I hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws.
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Signature of Contractor or Authorized Agent
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Save Time & Money with Online Permits and Inspections. Go To: www.buildingdepartment.com
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