24 Fort Avenue Registry of Deeds Fee City of Salem Department of Planning and Community Development
Check Receipt and Tracking Form
Please complete the form and make two (2) copies
Date Received 5 f 121 ,. s
Amount Received 110 5,00
Form of Payment 2�Check ❑ Money Order
Client Information Fore A ven U e
Arts& Culture land Use Boards
❑ Artists' Row Rent ❑ Planning Board Application Fee
❑ Charlotte Forten Plaza Use Fee ❑ SRA/DRB Fee
Payment received for ❑ Derby Square Plaza Use Fee ®' ZBA Fee
❑ Old Town Hall Rental Fee ❑ Peer Review Fee
what service? ❑ Security Deposit for Escrow Acct. ❑ Conservation Commission Fee
Other
❑ Salem Ferry
❑ Other
Staff receiving payment ?Brel'i tlar) Pp� f.t h
Additional Notes
Lf Farb Avenue — 1105 ,00 R e5L' qyo-f Deeds Fee
BOWDITCH AND DEWEY, LLP Citizens Bank 020478
311 Main Street 5-7017/2110 Date Amount
P.O. Box 15156 04/22/2025
Worcester, MA 01615-0156
Pay: One H n Ired Five and 00/1 10 Dollars
VOID IF NOT CASHED WITHIN 120 DAYS
Pay The Southern Essex Registry of Deeds 8
To the The Southern Essex Registry of Deeds
Order of f3Y
TWO SIGNATURES REQURED
FOR AMOUNTS
EXCEEDING$25,000.00
1100 20 4 ?130 1: 2 L LO ?❑ L 7 51: L 3 30 2 4 5080 n'
Original Check and Form: Treasurer's Office
Copy 1: Client r
Copy 2: Application File
Scan and email if required