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1996, 04-15 Permit: 96001310 RefundPv# Dept IMMO& HEAT TRANSFER INC 3003 N CrESTLINE SPOKANE Vendor Contact/Tel WA 992 LGFS PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR SHIP TO: BIL TO: Confining Order Change Order # Bid ID Blanket# RC# VI# FOB: u�/9b ACCTG. PERIOD: COMMENTS - COMM LN# DESCRIPTION PO DATE: DELIVERY DATE: ENTERED BY BLDG/ROOM: WAREHOUSE: BUYER PURCHASING DIRECTOR COMMODITY NO REF ACCT LINE 1 QUANTITY UNIT UNIT PRICE TOTAL PRICE cC e r'w� ::9603131 j 1918 S Conklin DINE NO. FUND AGCY I ORG SB ORG I ACT OBI SB OBI REV SRC SB REV G PAGE TOTAL: DISCOUNT TOTAL: FRIGHT TOTAL: SALES TAX TOTAL: PURCHASE ORDER VALUE: USE_ TAX TOTAL: = I RAND TOTAL: RPT CAT I BS ACCT JOB NO. 32.30 0.00 0.00 0.0: 32.80 0.00 32.10 PAY THIS AMOUNT P/F RECEIVING CERTIFICATION Materials noted in quantity ! have been received in good condition or contracted for. SIGNED TITLE DATE PAYMENT CERTIFICATION 1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the materials have been furnished, services 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 authorized to authenticate and certify to said claim. SIGNED TITLE t. r 4 Lo r DATE DEPARTMENT 2 TRAVEL CERTIFICATION 1 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 PAGE