Hill- Assessment Fee- 6-19-17City of Atlantic Beach
Offsite Payment Form
Date prepared: 06/19/17
Deposit Date: ('10117
Prepared by: Donna Bartle
Payment
Cash
GL Account or
Type
Receipt
Accounts Receivable
Deposit
Code
Number Description
Number
Amount
ON
Assessmentfse for Candidate - J. Hill
001-0000-369.90-00
59.01
Total Deposit 59.01
Cash
ACH
Checks 59.01
Money Orders
Total 59.01
Oper: ATLBBJA Type: OE Grauer: 1
Revised: 9/06/07 Gate: 6/19/17 00 Receipt no: 64190
IN NON-SPECIFIC
OACity ClerkVNIERNAL 0SEIELECTIONS 201TFor Oualrtyine\[Copy of OOsits Payment Form -J. HIILAs]Foeo 1.00 $59.01
00100003699000
ASSESSEMENT FEE -HILL
Ck CHECk 631 $59.01
Trans date: 6/19/17 Time: 14:19:03