SIgnature Sheet CE-2015-0053 .tif I
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DATE LETTER PREPARED: July 22, 2015
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I have received a letter addressed to:
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ROBERT A AND LORI R HAYDUK
1757 FRONT ST
BLAI R, NE 68008 -0000
: 1751 Front St
Signature of person receiving letter
Printed name of person receiving letter
Signature r n delivering letter
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Date a dti "ef delivery
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218 S 16th Street • Blair, Nebraska 68008 •402.426.4191 • FAX 402.426.4195 • E -mail: cityofblair @ci.blair.ne.us