Sec. 5-107  Form of Receipt.
   The Clerk-Treasurer of the Town of Schererville shall issue a receipt for any and all impact fees collected, and the form of such receipt shall be as follows:
“Received of                                        (fee payer)                          this               day of                   , 19        , the sum of                                                 in (full) (partial) satisfaction of impact fees due pursuant to Ord No.       relating to improvements to be constructed on the real estate described on Exhibit A., attached hereto, made part hereof, and subject to lien rights in favor of the Town of Schererville in the event of partial payment with payments remaining due. The remaining balance due (if any) is in the following amount: $              . This impact fee is dedicated to the creation of the following infrastructure element in accordance with the Zone Improvement Plan:
            
   Clerk-Treasurer
   Town of Schererville, Indiana.