Ford - Assessment Fee - 8-29-22 City of Atlantic Beach
Offsite Payment Form
Date prepared: 08/29/22
Deposit Date: 08/29/22
Prepared by: Donna Bartle
Payment Cash GL Account or
Type Receipt Accounts Receivable Deposit
Code Number Description Number Amount
UN Assessment fee for Candidate-Curtis Ford 001-0000-369.90-00 106.72
Total Deposit 106.72
Cash
ACH
Checks 106.72
Money Orders
Total 106.72
Oper: ATLBNRP Type: OC Drawer: 1
Date: 8/29/22 00 Receipt no: 88678
Revised: 9/06/07 UN NON-SPECIFIC
O:\City Clerk\INTERNAL USE\DONNAS\ELECTION 2022\Qualifying Paperwork\[Payment Form-Curtis Ford.xls]Form 1.00 $106.72
00100003699000
ASSESSMENT FEE FOR CANDI
CK CHECK 237 $106.72
Trans date: 8/29/22 Time: 15:34:05