1993, 08-09 Permit: 93000584 Refundpv'
Dept
VENDM:
£AVE
:805 SOUTH BATES AVENUE
'POKANE, SIA 992E"
vendor Contact/rel
S UP TO:
EPS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
CordhndoQ Order
SILL TO:
Change Order #
Bid ID
Blanket#
I2C# L ° 0000000€ 1
v1#
FOB:
ACCTG. PERIOD:
COMMENTS.
PO DATE:
DELIVERY DATE:
ENTERED EY-
BLDG/ROOM:
WAREHOUSE:
BUYER
PtIRCHA.SINC; DIRECTOR
COMM LN#
DESCRIPTION
COMMODITY NO
REF ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
.93000584
rA_59ia'Q 44
1.01 X 100%
::93000584
4.50 X 100%
:`9:000584
12.57 X 100
~93600584
54.00 x 80$
::93000584
65.00 X 80%
TOTAL REFI
2820 NORTH DORA ROAD - PROJECT CANCELED
$429.52
1.01
4.50
= 12.57
43.20
= 52 00
$542.80
v.00000o
ol?0000
0.000000
0.000000
0.000000
0.000000
PAGE TOTALS
'7:r T O'".._ .
+29.=2
x.01
4.5C
12.57
43.20
52.00
542.0
LINE NO.
FUND
AGCY
ORG
SB ORG
ACT
OBI
SB OBI
REV SRC
SB REV
RPT CAT BS ACCT MOB NO.
PAY THIS AMOUNT
P/F
V
03
04
06
406
406
406
U -
030 00t'.-
030 0006
030 00C'
000
2210
2210
4150
1173
3700
3170
GRAND TOTAL:
4G9.:.
43.20
52.0C
12.57
4.50
1.01
542.80
RECEIVING CERTIFICATION
Materials noted in quantity / have been
reoeived.in good condition or contracted for,
SIGNED \Q
TITLE
DATE t) '
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 I am authorized to authenticate
and certify to said claim.
SIGNED
DATE 4
TITLE
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 thereof.
SIGNED TITLE
DATE
PAGE