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