Kelly- Assessment Fee- 6-20-17City of Atlantic Beach
Offsite Payment Form
Date prepared:
06/19/17
Deposit Date:
Prepared by:
Donna Bartle
Payment Cash
GL Account or
Type Receipt
Accounts Receivable
Deposit
Code Number
Description
Number
Amount
UN
Assessment fee ter Caroplate- C. Kelly
001-0000389.00-00
59.01
Total Deposit 59.01
Cash
ACH
Checks 59.01
Money Orders
Total 59.01
Oper: ATLECCT Type: OC Drawer: i
Revised: 9/06/07 D
���Nate: 6/20/17 00 Receipt no: 64742
O:\City Cle&%INTERNALUSE LECTIONS201TFor OualifyingRCopyof OOsRe Payment Fmm-C. Kelly.A]Form NON-SPECIFIC
1.00
$59.01
00100003699o0O
KELLY - ASSESSMENT FEE
CK CHECK 64175612 $59.01
Trans date: 6/20/17 Time: 15:09:25