Hill, James- Assessment Fee ReceiptDate prepared:
Deposit Date:
Prepared by:
Payment Cash
Type Receipt
Code Number
City of Atlantic Beach
Offsite Payment Form
06/14/13
06/17/13
Donna Bartle
Description
Received
JUN 1 7 2013
Office of City Clerk
GL Account or
Accounts Receivable Deposit
Number Amount
UN Assessment fee for Candidate - James Hill 001-0000-369.90-00 57.73
Total Deposit
Cash
ACH
Checks
Money Orders
Total
57.73
57.73
57.73
OpEr T FYPe:
Revised: 9/06/07 Date: b/17/1:Ti t) ;!,t'ete ;i•
OACity Clerldintemal use\DONNAs\ELECTION 2013\Offsite Cash Receipts for Qualifying4Copy of Offsite Payment Form,- J.
I .00
U.010000359U0
JEIMES HILL
DK CHEN
270