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Home My WebLink AboutClaim form (sewer line) ~-p: ~y CLAIM FORM CITY OF O$tlISJ2~ff, WISCONSIN Date of Report:/.1- S - 9~$~t~~~~:~{~~cation: Name: .sir 4 "PI.:. tD,. ..;:::.:.:OOU:.IUI.I.:::.:::.:....::::...:.::..::.::::::... .: Address: ~{; ~%:: ~~i~~~::~~} ';, ~ - .....-. ...:,:.:::.:.:...l:.:.::..:.:;.:.:.:.....::.;.:-::.:::::.;.:" .':':':':':':':';' --i::.:......;::::.:...-..:....;.:~.:.:.:.:.:.;.:.:.:-:.:.:.;.;.:.:-. ..-. if6!() vh4#:~ '~;-P"J~1z~<<<<_~:!p~~r '~-PP6.. ~ '., .;:: ., ~~, ' , ,.,"~"~;"~'Mibq' ~ , "~,,., I : ~7:t:p~~1t:~ft,:Jv~~~",~~1/- I , . ' t.: :.::::) :: .!.~'.."..'i:i :...:.:::::.: ,::::/:\ :.:/'...:.\: i!?;:. :::.: I cf\- (J /)0 IP OtJ j ~ ::lk c) .Z< J}:~;;z/2""-7: t'J} ,-",,'L/ ()~~ .-kt'An6< . - ~ L $: ~ c:<:.- &t~ \0 -1' -<) OJ IJ/' hX/J L (J AAA0-r (/'J'LA~ /'77U~, .. /Jt1p.' ,9~ ~ ~ /I -----~ _ j:.--" RETURN TO: CITY CLERK P.O. Box 1130 OSHKOSH, WI 54902-1130 ~ ATTACH COPIES OF ALL BILLS ~cJ fS OZ- '7 ~A . '3 6 oo~- """.-r TOTAL CLAIM: $, 0 . --:~ ~ r~ rr; n Ni ~~ , , .. J ,\ ,; -, II;, : ~ f J .,1 f ;., '~ ; i i; J,..'_-::;;:;~-:-'~~~ ,. II i' CLAIMANT SIGNATURE I' .., ~ ~ I ! I ~ J :"; ~; f ~ f} i 1 FOR QUESTIONS CALL: CITY;CLERKDi,c ~3B-s011 dJ..JbTY ATTORNEY AT 236-5115 ~, : - ...... -: ". .,?~." . :.:~. .; . ,.,,'" . , ,....,. ." .. . , ..' _'_~',.'a______"_ ,.' ,.# ---- _..- _.-.- R.M. PAYNE EXCAVATING 4ftl Indian Point Road OSHKOSH. WI 54901 Phone 231-8465 SOLO BY '-:2. ---' NAME , _I .ir'# ?/ ,L ADDRESS .. ,y ds. Topsoil ----to- Yds. Fill Yds. Stone Cat ___ _Bac;:khoe . 'A-(:::' ~:<. 1.../:::!:::= Truck Pavloader .-d.-<-..f...-::::!!:. ;~_::::?:.... '.~ / / .-.--Lab.Qr ,".,... ,.../"-:-- .(1._._._-- .'::7 ../T j,)' ...J..... / I - _.~.... __.____H_._. _........_.__. ..-...-.......... ..--;:.------..- ------..- -.-.........-p. ':. .. v..(.,~77'~..cs::'-.:~ ?: .' . RECEIVED BY ,r/'-':': 1537 CJhank~u All clalma and returned goodS MUST be accompanied by this bill. .' , ./ ". ........... !.~ ';' . '.".; ; ,~ -~". ..' "::',~~ " "'~ '.' > l-', ' . ........ ;;.. . '.',"n . -, "'-.,.' ',~:-.'.,..:.::. " ~~, ~"~,')-',,' '. .. '! " .\'.~'" . . ~ . ! 1 .. '\ i J /' -............._1 I r t ~ ~ J ~, l ....-:.:.. ;.....~.:. 'f ~ t l' ~ Ii 't 'I i i l l' t j ,. 1 '1. It'.,,:' .....