1996, 01-31 Permit: 95006054 Partial RefundLGFS PAYMENT DOCUMENT
III ev# SPOKANE COUNTY AUDITOR
I Dept
VENDOR SES TO: BILL TO:
Uertdor Cordac1P4e1
Confatt®q Order
Change Otter #
Bid ID
Blanket#
RC#
vi#
FOB:
ACC TG. PERIOD:
COMMEN TS:
PO DATE:
DELIVERY DATE:
ENTERED BY:
BLDG/ROOM:
WAREHOUSE:
BUYER
PURCHASING DIRECTOR
COMM LN#
DESCRIPTION
COMMODITY NO
REP ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
P ;RCRA
PAs:
I SC3UNT
F 2I:;HT
wL TAA
JS= TAX
TOTAL:
TOTAL:
TOTAL:
TJ rAL:
`JALJ
TOTAL:
LINE NO. FUND I AGCY I ORG
SB ORG ACT
OBI
SB OBI
REV SRC
SB REV
RPT CAT
BS ACCT jOB NO.
PAY THIS AMOUNT
P/F
RECEIVING CERTIFICATION
Vaterials noted in quantity / have been
received in good condition or contracted for.
SIGNED
TITLE
DATE
OA
1 /31./96
PAYMENT CERTIFICATION
I, 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 1 am authorized to authenticate
and certify to said claim.
OFF ICE ADMINISTRATOR
SIGNED TITLE
1/31;
DATE
DEPARTMENT 2
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 thereoL
SIGNED TITLE
DATE PAGE