HomeMy WebLinkAbout1.04 Application receipt.pdfGarfield County 108 8th Street Suite 401 Glenwood Springs, CO 81601-RECEIPT Phone: (970)945-8212 Fax: (970)384-3470 Invoice Number: Invoice Date: Plan Case: INV-11-13-22725 11/27/2013
12:00:00AM Limited Impact Review Applica Fee Name Fee Type Fee Amount Limited Impact Application Fee Fixed $400.00 Total Fees Due: $400.00 Date Pay Type Check Number Amount Paid Change
12/02/2013 Credit Card -1 $400.00 $0.00 Total Paid: $400.00 PAYMENTS Total Due: $0.00 Monday, December 2, 2013
Community Development 108 8th Street Suite 401 Glenwood Springs, CO 81601 MERCHANT # 941000097881 SALE REF NUM: 333615334255 MASTERCARD ************1886 EXP.: **** INV NUM: LIPA-7775
DATE: 12/2/2013 TIME: 8:55:08 AM AUTH NO: 053227 AVS: Z CVV: PO NUMBER: Tax: TOTAL: $ 400.00 Customer Name: VICKY SCHOEBER CUSTOMER ACKNOWLEDGES RECEIPT OF GOODS AND/OR SERVICES IN THE
AMOUNT OF THE TOTAL SHOWN HEREON AND AGREES TO PERFORM THE OBLIGATIONS SET FORTH BY THE CUSTOMERS AGREEMENT WITH THE ISSUER. printReceipt Page 1 of 1 https://www.payeverywhere.com/Transaction/printRe
ceipt.aspx?transactionID=29960841 12/2/2013