Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1992, 10-19 Permit: 92002866 Refund
VENDOR REFUND CODE NAME MICHAEL 0. PHILLIPS SPOKANE COUNTY PAYMENT VOUCHER ADDRESS SOUTH 1106 BURNS ROAD VERADALE, WA 99037 LINE NO. VENDOR INVOICE NUMBER ACCOUNT DISTRIBUTION, ORIGINATING ENTITY (ALL VOUCHER TYPES) FUND AGENCY ORGAN- IZATION ACT OBJ SUB REV SUB OBJ SOURCE REV JOB NUMBER REPT CATEG BS ACCT AUDITORS STAMP 0 1099 REO'D ID# DESCRIPTION AMOUNT 1 92-002866 130 0008 REFUND 63.97 DETAIL DESCRIPTION 1 $0% REFUND ON PERMIT #92-002866 FOR 1106 SOUTH BURNS ROAD PROJECT CANCELED PER COPY OF PERMIT & LETTER ATTACHED RESIDENTIAL VALUATION $63.00 COUNTY SURCHARGE 11.34 $74.34 X 80% * $69.47 STATE CURCHARGE 4.50 X 100% = 4.50 $63.97 INTRA -GOVERNMENTAL VOUCHER SELLERS ACCOUNT DISTRIBUTION FUND AGENCY ORGAN- SUB ACTIVITY IZATION ORG REVENUE SOURCE SUB REV SRC JOB NUMBER RPT. CATEG. OFFSET RECEIVABLES ACCOUNT SELLER CERTIFICATION 1, 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. - StGNE `?F` '7 ''NISTRATOR TITLE CERTI ION DATE 10/20/92 TOTAL 63.97 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 sj)t1g i2 1/25, cJoRw ��.5ct2113f b ©N ON "7rMt5 ATT -1 ci-i c & RAGE 1%1CL05E4. PFRr►'tt i ASAS NW(/ $THRTE J A5 F-1.1 Roi? ConrS7%<'uc T)OnJ (.4 4U60E/2 race: 4.1tl2f b .1 u -(LL ISE-A?PL1? ' gile4 ANy R£FunJbS OF TME 12. -vi t7- C0ST- O n% PNCC «Sfrb i24_GtG400 . b &R£ATL`t' ptpetefc1 Tb ttJ T174.1/2c, I i-4,#\) w t 10 V ii?hivi-L arq . l?o37