1992, 11-04 Permit: 92009711 RefundVENDOR
CODE
?Fl
SPOKANE COUNTY. PAYMENT VOUCHER NUMBER 132012
NAME ` e' "NY
ADDRESS 7520 NORTH MARKET STREET
WA 99207
ACCOUNT DISTRIBUTION, ORIGINATING ENTITY (ALL VOUCHER TYPES)
DATE
AGENCY
NAME
AUDITORS STAMP
❑ 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
12.00
DETAIL DESCRIPTION
1 PERMIT #92-009711 FOR 7802 EAST BUCKEYE AVENUE REFUND FOR ONE TOILET
AND ONE SINK. TWO ARE BEING INSTAItFD. ONE OF EACH WAS PAID FOR BY PERMIT
#92-005955 AT TWO MORE WERE PAID FOR ON THE ABOVE PERMIT, REQUIRING
A $6 REFS FOR EACH.
$6.00 X 2 = $12.00
FUND
ORGAN-
IZATION
SUB
ORG
INTRA -GOVERNMENTAL VOUCHER
SELLERS ACCOUNT DISTRIBUTION
ACTIVITY
REVENUE
SOURCE
SUE
REV
SR
JOB NUMBER
RPT.
CATEG.
OFFSET
RECEIVABLES
A • .T
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services
rendered or the labor performed as described herein or contracted
for, and that the claim is a just, due and unpaid obligation, and that
I am authorized to authenticate and certify to said claim.
SIGNED
TITLE
DATE
I, the undersigned do hereby
certify under penalty of perjury
that sufficient funds have been
budgeted for this claim, the ma-
terials have been furnished, ser-
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
indicated above, that I am autho-
rized to authenticate and certify
to said claim.
CERTIFICATION
SIGNED
TITLE
ADMIINISTRATOR
DATE
11/4/92
TOTAL
TRAVEL CERTIFICATION
I hereby certify under penalty of perjury
that this is a true and correct claim for
necessary expenses incurred by me and
that no payment has been received by me
on account thereof.
SIGNED
TITLE
DATE
EXAMINED and ALLOWED
DATE 19
CHAIRMAN
MEMBER
MEMBER