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Receipt 77925 5-4-05
RECEIPT CITY OF 7700 MARKET BLVD.· P.O. BOX 147 CHANDH'SEN CH. ANHASSEN, MN 55317 JIM /J¡HONE' (952) 227-1100 RECEIVED OF meòn No. 77925 5 ¡" /oS- I DATE PERM/LIC. AMOUNT FUND SOURCE OBJ. PROG. -'-to tJ " TOTAL AMOUNT 1.::5 C:t:JO e9-- I I . CHECK IT CASH 0 "#=¡ dQ8aJ -.---- -----" Invoice No. Invoice Date Description 05/03/05 Jobn 76900/1/0160.00 Gross Amount Retainage Discount Payment Amount 5,000.00 76900 5,000.00 Check #: 120821 05/03/05 30991 City of Chanhassen 5,000.00 .00 .00 $5,000.00 REORDER FORM #665L (1 PART) USE WITH COMPANION ENVELOPE #44-005