1992, 01-22 Permit: 92000337 Partial RefundVENDOR ',i:., IND
CODE
NAME i AW:211isvOP111I T1,
ADDRESS
SPOKANE COUNTY PAYMENT VOUCHER 29 4 31
EAST - - (Ti ;:\''IR j -
DATE
AGENCY
NAME rriT . \171 -r,71.1. -m-: I
AUDITORS STAMP
ACCOUNT DISTRIBUTION, ORIGINATING ENTITY (ALL VOUCHER TYPES)
• 1099 REQ'D ID#
LINE
NO.
VENDOR
INVOICE NUMBER
FUND
AGENCY
ORGAN-
IZATION
ACT
OBJ
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
REPT
CATEG
BS
ACCT
DESCRIPTION
AMOUNT
•i
C1', i( n1
9-76
`;gin
in
98}
REFUND'
1
DETAIL
DESCRIPTION
ON CHECK #tj,]w FOR 'J6,.5^
I, the undersigned do hereby
certify under penalty of perjury
TOTAL
5.00
,EFUND
funds have been
PERMIT 9200339 C. 2114 S. 3O4lISH $45.0fl
PERMIT O?C Y 337 7C 2402 S. SOWDISH 45.80 �In.:.i2 cn
that sufficient
budgeted for this claim, the ma-
terials have been furnished, ser-
TRAVEL CERTIFICATION
I hereby certify under penalty of perjury
that this is a true and correct claim for
EZIt 5.1)2
PER COPIES OF PERMITS e, CHECK ATTACHED
vices rendered or labor performed
as described herein or contracted
for, that the claim is a just, due
and unpaid obligation against
Spokane County or fund agency
necessary expenses incurred by me and
that no payment has been received by me
on account thereof.
SIGNED
indicated above, that I am autho-
to
TITLE
INTRA -GOVERNMENTAL VOUCHER
rized authenticate and certify
to said claim.
DATE
FUND
AGENCY
ORGAN-
RATION
SUB
ORG
SELLERS
ACTIVITY
ACCOUNT
REVENUE
SOURCE
SUB
sic
DISTRIBUTION
JOB NUMBER
RPT'
CATEG.
RECEIVABLESEXAINED
ACCOUNT
and ALLOWED
19
COTIFICATION
DATE
SIGNED \ \ r -- _ j
CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
TITLE O•r7 ICE AD^1INISTRA! R
MEMBER
rendered or the labor performed as described herein or contracted
for, and that the claim is a just, due and unpaid obligation, and that TITLE
I am authorized to authenticate and certify to said claim. DATE
DATE 1/22/92
MEMBER