266 Canal Street ROD 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 % 9-0 z -
Amount Received J L 05 „o o
Form of Payment R Check ❑ Money Order
Client Information -Ab G 6dr,60 ' +4eP+
Arts& Culture Land Use Boards
❑ Artists' Row Rent ❑ Planning Board Application Fee
❑ Charlotte Forten Plaza Use Fee ❑ SRA/DRB Fee
❑ Derby Square Plaza Use Fee 0 ZBA Fee
Payment received for ❑ 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 Uenlior? Po5 fl (h
Additional Notes
�jb Lanai 5+(_eet- 900 FeO
THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER 1-7-1
Beverly Crossing LLC
15 Rantoul St, North Shore Bank` 637
Beverly, MA 01915 53-7129/2113
DATE: May 29, 2025
PAY 0
ONLY
R PAY Two and 00/100 Dollars d
To THE CITY OF SALEM
>ORDER
OF SALEM, MA 01970 I
I
"
T}E SACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK-HOLD ATAN ANGLE TO VIEW
118000637ii' 1: 211371 29al:9946 L L98ii'
Original Check and Form: Treasurer's Office
Copy 1: Client
Copy 2: Application File
Scan and email if required