SIPlive: Juab County Clerk (L.?)

Juab County Clerk
435-623-3410

Marriage License:

$50.00

Quantity:

Item Subtotal:

$0.00

Marriage License Copy:

$10.00

Quantity:

Item Subtotal:

$0.00

Marriage License Certified Copy:

$15.00

Quantity:

Item Subtotal:

$0.00

Business License:

Item Subtotal:

$0.00

Name of Business	[1]
Name of Business	[2]
Name of Business	[3]
Name of Business	[4]
Name of Business	[5]
Name of Business	[6]
Name of Business	[7]
Name of Business	[8]
Name of Business	[9]
Name of Business	[10]

Landfill:

Item Subtotal:

$0.00

Passport Fee:

$35.00

Quantity:

Item Subtotal:

$0.00

Passport Photo:

$10.00

Quantity:

Item Subtotal:

$0.00

Digging Permit:

$30.00

Quantity:

Item Subtotal:

$0.00

Misc Amount:

Item Subtotal:

$0.00

Description	[1]
Description	[2]
Description	[3]
Description	[4]
Description	[5]
Description	[6]
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Description	[8]
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Description	[10]

Total:

$0.00

Payer's Information

First Name:		Last Name:
Phone:		Email:

Payment Information

Method of Payment:

Processing Fees:

Credit cards: 2.5% ($1.50 min)
(+1.5% processing fee for foreign cards)
eChecks: $0.50

	Update name from Payer's Information
Name of Individual on Checking Account: Name of Individual on Savings Account: Name of Business on Checking Account:
Bank Routing Number:
Bank Account Number:

Credit Card Number:
Expiration Date:	/
Card ID (CVV2/CID) Number:	What is the Card ID?

Cardholder Information (exactly as it appears on your statement)
	Update from Payer's Information
Cardholder's Name:

Billing ZIP/Postal Code:


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