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Correspondence 1989-1992 Waldron
Roseville
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Correspondence 1989-1992 Waldron
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Last modified
2/18/2016 8:22:13 AM
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2/9/2016 1:05:35 PM
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I <br />•� �.1 � <br />��.ms�� Cou�.ty Claim <br />TO BE FII.LED OUT BY COUNTY DEPARTl�Ai'T <br />(�) CHARGE T0: Dept. CqMMUNITY & ECONOPIIC DE�IELOPr9ENT <br />(2) Appropriatian Item <br />• - - - - - - - - - - - - - - - - - - - - - -I (3) <br />� <br />� Claim �b Date Paid I J� RFC Fun <br />I � <br />� i cA i <br />I I <br />� 2 � <br />I i <br />13 i <br />I � <br />14 <br />I 1-2 3-fi � 9-i� � <br />� .. _ _ _ � _ _ _ _ _ _ _ _ a � _ _ _ _ � _ ,�� <br />�(#� PAY T'0: <br />15-17 1�- <br />Fi rs c t�a�cs� � I n i t f al (�i0 �IC�fiATi <br />ROS�V'� 1 �� �.ACa3) ��Y@��,�t�r11 �Ot'DO <br />L�� c a�cr..�c� c�r E�'� r� C�a�� <br />26G0 C�vi� C��t�►� �►•iv� <br />•5�-7� <br />�d���s� ���Z <br />R�s�vili�, �� <br />�ity S��c� ��Q�� <br />Qt► Ch�k Stu� F�� : <br />...... <br />� �=6t? <br />�-b0 <br />Date <br />Warrant No <br />(ASSIGN� BY B&A ONLY) <br />� <br />21-25 <br />ect I Amaunt <br />26-31 <br />S <br />S <br />32-41 <br />$ <br />To t aI <br />S�c �ac Nas - : - - <br />OR <br />��� 4.�.' 06_0����� <br />�I� 55�59 FQd �'ax I� b0-71 <br />I da�lt��ct ch�� �he �bca�� ���ca�.l� �v�dBt�� ���,�ic#�� hra�+� <br />b�e�r� r��e�e��d� ��� ��a� F���*�r ��a�fl�y. �.���.;�y� ��r a�r.�, ���D <br />opp��v�� ��� ���y��n�. <br />Auch��i�e�d Si,�naturQ - Ct►uncy <br />�r�rs�s�� �t � �� � � s �►��� � rr�r� � � � a,� � � e�� � r� �► r► � �t � � � � � �,� �r �r r�,� �r � �t� rr s� ��,� �r r �i �,��r�r � ��r���,�� ��rat��r��rst� �t,��t�a** <br />TQ �� �II.L� tl�' B� �,H� <br />CLAI��"i �����rill� LaC�i Q���R����t �c�r���r+�ti�n t�a�� t�____ <br />�d+d.��� ���� ��� �� ������' ��`����. �����a i t i�, "�`� ����3 <br />Y <br />nt�� <br />� <br />���er: ��;��� <br />l�l�n� ��r V i 1 1 f� �€�r� �6r ���;� <br />��ct�eh�� d���������t�ti��,� <br />��r Mi��eaaca ScAtue�e ��'1.391� �ub. � <br />d�c��r� uc�der �h� ��n�lei�: �f law rh�c rili.v <br />�ccaunt, C�Bift► r,r• dt�c��anci ia ju�t and cc,rreer t�nci <br />th�t r�c, p�rt �f it h�� ��een p�i�i. Claimant' � SSN: - - _ <br />OR Fed Tax ID : 4�1— 6 0 0 7 8 4 9 <br />(Requix�d iar Annual Inf�rmati�n Retunis: <br />Cecieral 1099. Minnesata M-9) <br />i�ni e gt�ice I As�e�unt <br />zo.oaa loo <br />�---�`-`=��� <br />Sigt�ature �f <br />,� <br />Aim�n <br />�e�xm t3bA 30� (12-87 ) <br />
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