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HomeMy WebLinkAboutAgenda Report - February 6, 1985 (71)L- •. q...CDEWIL 1'1LLL1 J1K7 1 z.. 5 2Y,X 6 ' 985 E 4 CM NICATKNS CITY CLEW ABC LICENSES Applications for the following Alcoholic Beverage License were received: a) Avenue Florist and Gift 400 W. Lodi Avenue Lodi ,3 J Off sale beer and wine b) The Rex 9 N. Sacramento Street. Lodi On sale beer and wine c) The Corner Pocket 725 S. Cherokee Lane Lodi On sale beer and wine public premises d) Plaza Liquors 800 S. Cherokee Lane Lodi f sale general _ kh •' Y 2 . � i X 1s4 � S t 3 ? F M b ,4t � � i sMET '. Cur F Do not detach—k':i7arn ail copses Do Not Write Above This Liao -for Headquarters office Only APPLICATION FOR ALCOHOLIC BEVERAGE LICENSES) To: Department of Alcoholic Beverage Control 1901 Broadway Sacramento, Calif. 9581II S$f1Ckto!1 — (OISTRICT SCRVING LOCATION) The undersigned hereby applies for licenses described as follows: 1- TYPE(S) OF LICENSE(S) FILE NO. Orf `arLl,> �'� & 'vIi`F' Applied under Sec. 24044 ❑ Effective Date: Zssuas ce RECEIPT N / GEOGRAPHICAL CODE 39U2, Date Issued 2. NAME(S) OF APPLICANT(S) s e i — Temp, Permit Effective Date: 3. TYPES) OF TRANSACTION(S) FEE LIC. TYPE iF XSSUR? ;, Anthorty, , Jr. /3andra Re S r 1'.,•o.0101 201 Annual nee 23.10 4. Name of Business Avenue Florist & Gift 5. Location of Business -Number and Street 4Q0 F3Lodi Ayp City and Zip Code County Ln:; 35_24[) ;rt;, ; I TOTAL $ 961 6. If Premises Licensed, 7. Are Premises Inside Show Type of License City Limits? v� 8. Mailing Address (if different from 5) -Number and Street ffo,npi if erml Same ppay-rr. 9. Hayc,�ou ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Alcoholic Beverage Control Act or regulations of the Department per - Fd" `- taining to the Act? t 11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. 12. AL plicant agrees (a) that any manager employed in on -sole licensed premises will have. all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. 13. STATE OF CALIFORNIA County -of ----------- 11_JQagaA__-____-__ 1 _, _ �2 �t ----Date ----- - � -' -------------- Under penalty of perjury, each person whose signature appears below, certifies and says: 11) He is the applicant, or one of the applicants, or an em .1; e - oFF—r of the applicant corporation, namedin the foregoing application, duty outhorieed to make this application on its behalf; (2) that he hasread the form going application and knows the contents thereof and that each and all of ehe statements therein made are true: (3) that no person other than rhe opp!icont or applicants has on.y direct or indirect interest in the applicant's or applicants business to be conducted under the lice .s sl for which this application is mode; (4) that the transfer application or proposed transfer is not mode to satisfy the payment of a loan or to fulfill an agreement entered into more than ninety ;qg) days preceding the day on which the transfer application is filed with the Department or to gain or establish o preference to or for on:- creditor of transferor or to defroud or injure any creditor of transferor; (S) that the troruFer appl;c.t;o,, may be withdrawn by either the applicant or the licenseewith no resulring liability to the Department. „ 14. APPLICANT ` SIGN HERE f _ cr- /,{� - ------------------------------------------------------------- 'o ----- --- ---------------r t 4 'fs-� tr. W_PQ 1% Rurwt-cnR,':t' h=y 44 Y s - APPLICATION BY TRANSFEROR 15. STATE OF CALIFORNIA County of -------------------------------------- Date ----------------------------- Under penalty of perjury, each person whose signature appear, below, cersif es and soy,. (11 He is the I;cen,*e,, or on e,,cvti,e officer of the corpora-, licenssr-. named in the foregoingtran sferapplication, duly outhorixed to make this transfer oPPI;cotion on its b,hol'; 0) that he Kst-by makes oppii—i­ to —ene— all interestin the attached lic*ns*(%) described below and to transfer some to the applicant ond,or location indicated on the upper portion as this ..p;k.'i.n far-, if such transfer is -Pp'—d! by the D;,—I.e; (3) that the vonsler application or proposed transfer is not mode to satisfy the payment of . I.— — to fulfill an agreement entered into more than ninety day, Preceding the day a- which the 1-011 -pplicotic,n is filed with the Deportment or so go;n or establish a preference to or for any creditor of transferor or to -defraud or iniire any credi-or. of transferor, f4) that the transfer application may be withdrawn by either the applicant or the licitissee with no resulting liability to the Department. riJ 16. Nome(s) of Licensee(s) 17. Signature(s) of Licensee(s) 18. License Number(s) Hit 19. Location Number and Street City and Zip Code County Do Not Write Below This Line, For Department Use Only Attached: F-1 Recorded notice, [:] Fiduciary papers, El -------------------------------------------------- -- COPIES MAILED -------hit 5--------------------- --- fOTMERI ❑ ------------------------- F] Renewal: Fee of ----------- Paid at._____________________________ Office on ------------------Receipt No. ---------------------- 87331-U>4 6A3 2D U Wr - OSP ABC 211 (1-82) -1 �Jj Ji"J 'k. 9J70C 14kjr �Q-'I Oct A 130 ", 777 -1 �Jj Ji"J 'k. 9J70C 14kjr �Q-'I Oct A 130 C06"hT Do `trn ' o no4 detach---R®tarall copra Co Not writes This U++e—fav Headquarters Office Only APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) I. TYPE(S) OF LICENSE(S) FILE NO. On tale Beier & viine 70: Department of Alcoholic Beverage Control 1901 Broadway Sacramento, Calif. 95818 Stk)CY�tal1 RECEIPT NO GEOGRAPHICAL (DISYRICT SERVING LOCATION) CODE .3`902 _ The undersigned hereby applies for Date licenses described as follows: N Applied under Sec. 28044 ❑ Effective Date: ISSl:aT1CC? Issued 2. NAJv14($) OF APPLICANT(S) Temp. Permit fL 38-899`i Effective Date: JJACi 0. ''d, Keely ivi- 3. TYPE(S) OF TRANSACTION(S) FEE LIC. TYPE $;50.00 4". 4. Nome of Business rl i` e 5. Location of Business—Number and Street City. and Zo Code County $ L x,.i, >6246 TOTAL i50. 01'j 6. If Premises Licensed, 7. Are Premises Inside Show Type of License ) City Limits?F' 8. Mailing Address (if different from 5)—Number and Street (Temp) (Perm) 9. Have you ever been convicted of a felony? _ 10. Have you ever violated any of the provisions of the Alcoholic S Beverage Control Act or reIQQtions of the Department per- �)o ' taining to the Act? j(JQ 11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. 12. Applicant agrees (a) that any manager employed in on -sale licensed premises will have all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of •the Alcoholic Beverage Control Act. .�dS, ;l .;C;dC�illl 13. STATE OF CALIFORNit County 'of --------------------------------------Date---------------------------- Under penalty of perjury each person whose signature appears below, certifies and. Boys: (1) He is the applicant, an. of the applicants, or on "ecuti•:e officer of the applicant corporation, na:•ted in the foregoing application, duly autbori:ed to make this application on its behalf; (2) that he hos read the fare•' going application and knows the contents thereof and that each and all of the statements therein made ore true; 0) that no person other than the applicant or applicants has nay direct or indirect interest in the oppiicaN's or applicants' business to be conducted under the far which this application is made; (4) that the er,aver application or proposed transfer is not mode to satisfy the payment of a loon or to fulfill an agreement entered into more than ninety "go) days preceding the day on which the transfer opplicotion is filed wish the Deportment or to gain or establish o preference to or for os credilor of transferor or to -. •' defraud or injure any creditor of transferor, (5) that the transfer application may be withdrawn by either the applicant or the licenseewith no resulting 17obility to rhe Department. 14. APPLICANT SIGN HERE , t t. �: ' ------ -------------------"Zi'--------------- APPLICATION BY TRANSFEROR IS. STATE OF CALIFORNIA Counti of ---S11-jC4-iqL1ir4 -------------------- Date ----- 1-3(J-25 --------------- Urid., penalty -of p-jq'ry, each person who** signature appears below, carlifies and says: (1) He is the lie.".., or an e..C.liv* officer of the Corp.-.. license. ...—d in the foregoing application, duly authorized to make this transfer application on its behalf; M that he hereby makes applitotion to svrrvndv� a1fthe "ocheA li ',#escr1b*c1. below and to transfer same to the applicant and: on -'Woress, in location indicated the upper portion of this oppl;cntion. f &Vch t , is w9cial; (3)'fhot the fro -application application or proposed transfer is not modir to satisfy the payment of a loan or �(.otm.' if. . ram -V- to fulfill an! agreement, entered lklo:J11NOM iIs an ninety days'prect,pg the day an wb-,,k the transfer application is filed with the Department or to gain or establish' a ell prcf,ranzo to, or fai any creditor of trazisferor or to d*f,ctud-arp injure any creditor of --foror; (41 .that the transfer application may be withdrawn by either ch. -applicant, or - The Ucccn,r",with- no. ta-1he Dep -t -en , t 16. Nome(s) of Licensee(s) 177-Sianature(s) of Liceetsee(s) 18. License N11MIrsArtO -Randall C. F' 01A 19. Location Number and Street City and Zip Code County 9 N. Sacramento St., Lodi V7;2)40 n Do Not Write Below This Line; For Department Use Only Attached. Recorded notice, E] Fiduciary papers, --------------------------------COPIES MAILED ------------ ------------ (OTHER) Al El Renewch Fee of -----------Paid at----------------------------- Office on ------------------Receipt No.__________________---__ ABC 211 (1-82) ---- M41-10; 6/t3 21) k WT -!S? -A 37 -Jo )1112 18. dV I C NI "VIC SfIlf, t. 2" .......... . F t 1 t copyDo Stet detach—i III all cop;®s Do Hot Write .ebovo This lino—ior Headquarters Ortce only APPLICATION FOR ALCOHOLIC UVERAGE LICENSE(S) To: Department of Alcoholic Beverage Control 1901 Broadway Socramenio, Calif. 95818 Stmktor. (DISTRICT SERVING LOCATION) The undersigned hereby applies for licenses described as follows. 1. TYPE(S) OF LICENSE(S) -�—r FILE NO, ON SAIk �BE7T'l'�{�yAA+N�D��T ��77D7^�E PUBLIC �1041Jt-S Applied under Sec. 24044 Effective Date: 7Ssua:xn REqfIPT, GEOGRAPHICAL CODE JJt.iY Date Issued `- 2. N`%M£(S) OF APPLICANT(S) Temp. Permit Effective Dote: 11 s-mam, jO Ly-rme & Robert warren. 3. TYPE(S) OF TRANSACTION(S) FEE LIC. TYPE _ '2---r to ;ger SL50.00 42 1 4. Name of Business T,hc Corner Pocket 5. Location of Business -Number and Street 725 S. Criercket:: Lane City and Zip Code County 1.A14.11i. 9;)240 S::; Jcaquirl TOTAL S 15C,rr 8. If Premises Licensed, 7. Are Premises Inside Show Type of Ucense 42-06060 City Limits? ye -S 8- Mailing Address (if different from 5)—Number and Street tramp) tPertrii Y. Have you ever been convicted of a telony"I lu. Have you ever violated any of the provisions of the Alcoholic ,6, rv_ Beverage Control Act or regulations of the Department per- tainingto the Act? N11D 11. 1xploin a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. 12. Applicant agrees (a) that any manager employed in on -sale licensed premises will have all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. 13. STATE OF CALIFORNIA County of mss � t f-------------------- Dote__?,2�—_ 85 ------------------ Under --------------.-.Under penalty of perjury; each person whose signature appears below, certifies ani says: (1) He is the opplicont, ar one of the appGmnn, or o eze<utisv 0ICKer of the applicant corporation, named in the foregoing application. duly authorized to make this application on its behalf; t2; that he has read the fore- going oppl;cotion and knows the contents thereof and that each and oil of the statements therein mode are true; (3` that no person other than the opplicont or applicants has any direct or indirect interest in the applicant's or applicants' business to be conducted under the licensets) for which this application is made; (4) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill on agreement entered into more than ninety p0;. do" preceding the day on a or which the transfer application filed with the aeptmeat o r to gain or establish o preference to or for os ran creditor of tsfer.,- or to defraud or injure any creditor of tronsferot; (51 that the transfer application may be withdrawn by either the applicant or he licenseewith no resulting liobillty to the Oepmtment. 14. APPLICANT c, / _,= SIGN HERE t_ .j_G• - `---- =--_- -- r APPLICATION BY TRANSFEROR 15. STATE OF CALIFORNIA County of ------------ ----------- Date ------------- Under Penalty of penury, each Person who _s;gnofura oPp.." below, cerfifin and soYs:. (11 He ;s rhe l;crnsve, or fin c.vcvri.. officer. of he c—-------- o•vo.ore .,nomad in the foregoing transfer oPPlicalion„duly oufhorized to make this transfer oppli<or on on its behalf; i2} rhos he heroby make: oGPtico+ion. . wr•ends all nterest in the onoched ficense(s) described below and to f onsfer some to the oPPlicant nd o, jo t;on ind;cored on the upper Gonion a. rean h;s aoPP1,_, on form, if such transfer is approved byaha Oiric!.or; (3) shot the transfer opplicotion or. Proposed t onsfer ismo nor de to s 14fy the Poym.nt of .dor ro fvtfili an ogm.—t entered .nto more then ninety days preceding the cloy on which- the transfer opp1;canon ;s Fled with the Deportment or so gain w-rstablist+ o .:¢ 7.. preference to or for any credit..tr of tronsftror or to defraud or iniure eny creditor of transferor, tt) that ;rhe I,an.ter oppticorion may be-withdrowr. by ..the, he X appcicont or the licensee- with. no resulting .liability to ths.0aportmant.. - - --• ---___ . _. ._. ,- _ ... 16. Nome(s) of Licensee(s) 17. Sianoture(s) of Licensee(s) 18. License Nurrrber(s) Y - ret m. Boover r• - e.7CO 14. Location Number and Street City and Zip Code County Jrv. a -; i n Do Not Write Below This Line; For Department Use Only Attached: )xJ Recorded notice, E] Fiduciary papers,EI , 5. -------------------------------------------------- MAILED-------L-=2a=P ------------------------ (OTHe.R) QRenewoi:Fee of. ----------- Paid w ----------------------------- Office on ---------------__ Receipt No ------------- ----------- ABC 211 (1.821 37331. -UX 6M 33 Y VM =(ST - e.7CO f�> i r_0 i Oo Not Write Above This Un*—Pw Neadaaart.rs orae. oniv APPLICATION FOR ALCOHOLIC savERAGIE lLICENSE(S) To: Deportment of Alcoholic Beverage Control 1901 Breadway stn Kt n Sacramento, Calif. 95818 (DISTRICT UCRV1Na LOCATION) The undersigned hereby applies for licenses described as follows. 1. TYPE(S) OF LICENSE(S) FILE NO. iia Lci r: f3 : .-i i Applied *rider Sec. 24044 Effective Dome: RECEIPT -NO. w ; f ) _ GEOGRAPHICAL CODE 39� 2 Date Issued 2. NAME(S) OF APPLICANT(S) Temp. Permit Effective Date: !ti:ilcir`i 't_/i=.o.(ti:�:: t 3. TYPES) OF TRANSACTION(S) FEE LIC. TYPE _.... $Ir27 . _ 4. _Name of Business 3. Location of Business—Number and Street Ci and Zip Code County r'K'aaF''�:-J!" : )... TOTAL $ 6. if Premises Licensed, 7. Are Premises Inside Show Type of License ` City limits? $,,M, 9iling Address (if different from 5)—Number and Street (Temp) (perm) 9. Have you ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Alcoholic 8eweroge Control Act or regulations of the Department per- toirning to the Act? :;141 11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. 12. Applicant agrees (a) that any manager employed in on -sale licensed premises will have all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. _ 13. STATE OF CALIFORNIA County of --------------------------------------- Dote ---`_-{__-'_'____ Under penalty of perjury, each person whose signature optseors below, certifies and saes; (1) He is the applicant, or one of the applicants, or on enecvtive *!ricer of the applicant corporation, "mod in the foregoing application, duly ovthariX,_A to make this application on its behalf; (2) that he'hos read the for. - going application and knows the contents thereof and that each and all of the staten.asts lhorein mode are true, (3) that no person other than the opplicant ac applicants has any direct or indiroct interest in the appli< nt'& or applicants' business to be conducted under the license(&) for which this application is made; (4) that the transfer application or proposed transfer is - . made to sot;sfy the poyma t of a loan or to fulfill an agreement entered into more than ninety (PD) days preceding the day on which the transfer application s filed with the Department w b gain or establish a preference to w for any creditor of transferor or to defraud or injure any creditor of Ironsferor; (5) that t'.e transfer application may be with Tawn by either the applicant or the license. with no resulting liability to the Department, 14. APPLICANT SIGN HERE ... APPLICATION BY TRANSFEROR 15. S � � n TATE OF CALIFORNIA County of ---------------------- JL --------------- Date ------------------------------- under penalty of perjury, each poison who,* signotvro appears blow, certifies and says: (1) He is 'he anM,., of the mined in the, foregoing transfer application, duly authorised to maks -his transfer OPPlilatian n if, behalf; (2, that he •1,.,.by make, -Pisli,oti­• o ­Ivridii, Oil Interest in the attached licenses) described Wow and to transfer some to the -PP""­ -I -nd,- Io indicated n he pp., portion of it;;suppli..ti.n form, if such transfer is approved by the Director; (3) that the transfer application of proposed I,unbf­ is 9l —.d. I. W -0y the payment t a bun o, to tuliil onAbor"mont entered into more than ninety days preceding the day on which the transfer opplic.11o. is GI.d will, the Department or I. q- .. ....Wish 'i;srehronce to or for any creditor of tronsforor or to defraud or Injure any ctiidllo, of transferor; (4) that the #-0.1 oppIi­Iin may be wimdro..n by he applicant or the litensGip with no resulting -liability to the Department. v 16. Name(s) of Licensee(s) 17. Signature(s) of Licensee(s) 18, License NuMbew(s) 19-10cotiork. Number and Street City and Zip Code County Do Not Write Below This Line; For Department Use Only Attached: Recorded notice, E] Fiduciary papers, I ------------_COPIES MAILED -------------------------------------------- IOTHfRr Office on _-__,Receipt No. J Renewal: Fee of ------------Paid at ABC 2- q-; 1p; Jt'Jj­ -J, It J eonardRus �.. E "1181 _ a .� so CLAIMS ADMINISTRATION SERVICE ,, -.� ,:., _ , , January 17, 1985 Calvary Temple of Lodi P.O. Box 672 Lodi, CA 95241 Attn: David A. Brown, Pastor Re: Insured: City of Lodi Date of Loss 12-29-84 Our File No.: 2651 LX 075 Dear Mr. Brown: The claim you submitted to the City of Lodi has been referred to us as we are the claims administrators for the City. In discussing this matter with the appropriate City personnel, I fail to find any negligence on the City's behalf upon which we could base a recommendation of payment of your claim. This City must have kncwledge of a deficiency before they can be held liable for any damages caused by it. We are recommending to the City that your claim be rejected. Very truly yours, Chuck Gormley CG/pw bcc: Alice Reimche - I suggest you send a formal rejection. In view of the.amount,we are just closing the file as I doubt that they will continue to pursue a claim this minor (famous last words!). 2424 ARDEN WAY BUILDING C-81 SACRAMENTO, CA 95825 916-920-5381 w .Y, � �Sir •• M CLAIM FOR DAMAGES TO PERSON OR PROPERTY INSTRUCTIONS I. Claims for death, injury to person or to personal property must be filed not later than 100 day, atter the occurance. (Gov. Code Sec. 911.2) 2. Claims for damages to real property must be filed not later than 1 year after the occurrence. (Gov. Code Sec. 911.2) 3. Read entire claim before filing. 4. See page 2 for diagram upon which to locate place of accident. 5. This claim form must be signed on page 2 at bottom. 6. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET, 7. Claim must be filed with City Clerk (Gov. Code Sec. 915a) RESERVE FOR FILING STA:" C LA.tt�l o TO. ALICE M. REIMCHE, CITY CLERK 221 W. Pine Street, Lodi, California 95240 Name of Claimant Ace of Claimant (if natural person) Calvary Temple of Lodi Home Address of Claimant City and State Horne Tel lione Number 441 Hilborn Street Lodi, California 95240 333-175 Business Address of Claimant City and State Business Telephone Number P.o.13ox 672 Lodi, California 95241 334-3103 Give address to which you desire notices or communications to be sent regarding this claim P.O. Box 672 Lodi, California 95241 How did DAMAGE or INJURY occur? Give full particulars. Toilet would not drain in Church. Ernie's Septic Tank Company was called. This wa3 Saturday afternoon on December 29, 1984 The line was full of sludge as the main sewer line in the alley was found to be full and backing up into the Church lines. Phoned the City and they When}, o�t�a 4+ .. . +he linea were opn for Sunder Services. d�� occ�Give full particulars, date, time of day: Saturday December 29, 1984 2 pm Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on reverse side of this sheet, where appropriate, give street names and address and measurements from landmarks: The main sewer line behind Calvary Temple Church located at 441 Hilborn St in Odi was full and backing up into the Church sewer lines causing the What particular ACT or OMISSION do you claim caused the injury or damage? Give names of City employees causing the injury or damage, if known. The City of Lodi Sewer Department, by not having the main serer line open. What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed: It cost the Calvary Temple Church $45.00 to have the line checked to find that the fault was the City of Lodi's. What AMOUNT do you claim on account of each item of injury or damage as of date of presentation of this claim, giving basis of computation. We ask that we be re. embursed for the $45..00 that it cost to have the sewer line checked, Give ESTIMATED AMOUNT as far as known you claim on account of each item of prospective injury or damage. giving basis of computation. Forty five dollars. Receipt from Erniets Septic Tank Co. enclosed. SEEPAGE 2 (OVER) 5-77-500 THIS CLAIM MUST BE SIGNED ON REVERSE SIDE am ➢Ernie's Septic Tank Co., Inc JO M YUM ONDEM P. n. Box 767 Loan, California 95240 Phone (209) 368-5105 21527 State Contractors License No. 328226 DATA 0/ ORDCR c _ Z / G i —,r-> CUSTOMCR'S OROER NO. !'NONE MEC NAN IC MELKR STARTING DATA �_i' SILL TO OR ER TAKEN BY ' /'✓tom% Z�wL�i�' /� Anon[as DAY WORK CONTRACT CITY E-XTRA JOB NAME ANO LOCATION JOe PHONE OLSCRIVTION O% WORK. TcCoE�'Lrnder the Mechanics Lion low (California Code of Civil Procedure, Section 1161 et %".I, any -_ ntractar, subcontractor, laborer, supplier or other person who helps to improve your property but is notpoid for his work or supplies, has o right to enforce o claim against your property. This means that, after a court hearing, your property could be sold by a court officer or>L' the proceods of the sale used to satisfy the indebtedness. This can happen even if you have paid your own cantracror in full, if the subcontractor. laborer, or scpplier remains unpaid." TERMS: Net Cosh. All accounts due and payable 10th TOTAL MATERIALS of month following purchases. 1'/a a/o SERVICE CHARGE per month will be added Tst of month following TOTAL I",1 purchase on overdue accounts. TRX �- DATE CON►LETCDWORK OROEREO eY l ' TOTAL AMOUNT ❑ No one home [] Total amoun. , ?ct2l billing to Signature due for above be i Z44 -d after I hereby acknowledge the satisfactofy completion of the above described work, work: or cor^bletio or wc-fz , �v .