HomeMy WebLinkAboutLagner - Assessment Fee - 6-9-26City of Atlantic Beach
► RECEIVED /
Offsite Payment Form
JUN !I 9 2016
Date prepared: 06/09/26
Deposit Date:
Prepared by: Donna Bartle
Payment Cash
GL Account or
Type Receipt
Accounts Receivable
Deposit
Code Number Description
Number
Amount
UN Assessment fee for Candidate - Jennifer Lagner
001-0000-369.90-00
112.43
ATLANTIC BEACH CITY
— 800 SEMINOLE RD
— ATLANTIC BEACH, FL 32233-5445
United States
— Phone (904) 247-5800
COAB.US
Received From:
Date: 06/09/2026 Time: 4:t6:Ul PM
Receipt: 0000034901
Total Deposit
112.43
ITEM REFERENCE AMOUNT
UN NON-SPECIFIC
ASSESSMENT FOR JENNIFER LAGNER $112.43
Cash
-
AC H
$112.43
IO1Al.
Checks
112.43
CHECK 0001 $112.43
Money Orders
Total Tendered: $112.43
$0.00
Total
112.43
Change:
Revised: 9/06/07
O:\City Clerk\INTERNAL USE\ELECTION 2026\Qualifying\[Payment Form- Jennifer Deery Lagner.xls]Form