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2. Big Lake Police Department Receipt

   A copy will be forwarded with the check/cash, and to the case file.

3. Date and Time Received
   Date and Time Received

   Date and Time Received
5. Sources
   -- Select One --CheckCashOther
6. Amount
7. Case Number
9. For:
10. Revenue Account
    -- Select One --101-075-3512 Parking Fines101-075-3513 Admin Cite/Other Fines/Fees 101-075-3230 Donations 101-075-3239 Donations - K9101-75-3240 Sales - K9101-075-3375 Miscellaneous Revenue101-075-3376 Insurance Proceeds101-075-3411 Copies/Data Requests101-075-3910 Sale Fixed Assets101-075-4200 Other Grant Proceeds101-075-4211 TZD Grant101-075-3160 Intergovernmental 101-075-4211 Federal Grant ProceedsFund 277 - DWI ForfeitureFund 276 - Narcotic ForfeitureBLCC Rental - 101-020-3940
12. Electronic Signature
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit Submit and Print

* indicates a required field