22 Vista Avenue 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
Amount Received
Form of Payment Check ❑ Money Order
Client Information 1, V15k0 N\feytge
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 19 ZBA Fee
what service? ❑ Old Town Hall Rental Fee ❑ Peer Review Fee
❑ Security Deposit for Escrow Acct. ❑ Conservation Commission Fee
Other
❑ Salem Ferry
❑ Other
Staff receiving payment P�renYLan P�y �crb,
Additional Notes
Xa, V;Sfd Averk — ROD Fee
r� North Shore Bank 2013
lint!&Navins,PG 63a12912113
Salem Operating'
27 Congress St,Suite 414
Salem,MA 01970 r. ..
PAS` One hundred five and NO/100 DATE AMOUNT
0
TO THE
ORDER OF Commonwealth of Massachusetts 05/15/2025 $105.00 a
Commonwealth of Massachusetts
Essex South District Registry of Deeds -
/ m
o
a
0
11'0020 L3112 1: 21 L 3 ? 1 2981: 99S L39 ? 311'
Original Check and Form: Treasurer's Office
Copy 1: Client
Copy 2: Application File
Scan and email if required