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City of South Bend <br />Engineering Division/Permit Office <br />227 W. Jefferson Blvd., Suite 1316 <br />South Bend, IN 46601 <br />Receipt No. 1768 <br />Date: 10/30/ 19 <br />RECEIPT <br />Payment Type Check/Ref # Amount <br />Check 59730 $ 50.00 <br />From: Burns Distributing Co., Inc. <br />Project Address: 3323 Prairie Avenue (SR 23) <br />For Project Name or <br />Number: UVF for Star 001, LLC - 3323 Prairie Ave (SR23) <br />Comments: J UVF paid in full <br />Payment received by: <br />