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PLC:

a006mz

Agency:

luce county clerk

For:

clerk fees - remote

Phone:

906-293-5521

Address:

407 west harrie street
newberry, michigan 49868

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*Name:

Middle:

*Last:

*Phone Number:

(### - ### - ####)

*Payment Type:

ATTENTION: If paying for Birth Record, please call the office for further information.

Notes:

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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:

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