MS-2011-00564_0002 (2).tif i
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CITY Of 5LAIQ
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Acknowledgement of Cash Deposit j
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acknowledge that I have received the
Please print name
$50.00 cash deposit that was held by the City of Blair for my building permit,
Building Permit #:
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Owner- 0ccupant /Contractor Date
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @ci,blair,ne,us