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City of Centerville <br />6Cent1880 Main Street <br />�teryiCCe <br />erville, MN 55038 <br />Estabfi,hcd j&5: <br />Verified Claim <br />Claim of: Kristine Steenberg <br />Amount: $100.00 <br />Address: .531:5 <br />City, State, Zip %f. � <br />Dated: 08/05/21 <br />Approved: <br />// /t , J.) �d �% <br />1 declare under the penalties of perjury that l am the Claimant making the within <br />claim and that the same is just and true; that the money therein charged was <br />actually paid for the purposes therein stated that the property therein charged <br />was actually delivered or used for the purposes therein stated, and was of the <br />value therein charged, that the services therein charged were actually rendered <br />and were of the value therein charged, that the fees therein charged are official <br />and are such as are allowed by law; and that no part of said claim has been paid <br />Signature of Claimant <br />Date: Z <br />Date <br />Activi Distribution <br />Amount <br />Total <br />Acct. No. <br />08i05;21 <br />Face Painter Appearance <br />$100.00 <br />$100.00 <br />%o — <br />Main Street Market - Sponsorship <br />Gio - American Family <br />$0.00 <br />$0.00 <br />Mark - Farmers Insurance <br />$0.00 <br />$0.00 <br />$0.00 <br />Totals <br />$100.00 <br />f$100.00 <br />37b <br />