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PLC:

a0037s

Agency:

city of loup city

For:

cemetery fees

Phone:

308-745-0222

Address:

134 south 8th street, po box 250
loup city, nebraska 68853

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Payment Information

*Name:

Middle:

*Last:

*Description of Fee Paying:

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number: