1992, 10-26 Permit: 92008304 Partial RefundVENDOR REFUND
CODE
NAME RON PHILLIPS
ADDRESS 11lO3—EAST GRACE AVENUE
SPOKANE COUNTY PAYMENT VOUCHER CIS 132001
10/26/92
SPOKANE, WA 99206
DATE
AGENCY
NAME
CODE ENFORCEMENT
AUDIT.ORS.STAMP
ACCOUNT DISTRIBUTION, ORIGINATING ENTITY (ALL VOUCHER TYPES)
•
1099 REQ'D ID#
LINE.'
NO
VENDOR
INVOICENUMBER,
FUND AGENCY
ORGAN-
IZATION.
ACT'
OBJ -
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
REPT
CATEG
BS
ACCT
DESCRIPTION
AMOUNT
1
92-008304
406
030
0008
221C
02
REFUND
mmum 63.72
-DETAIL
DESCRIPTION
1 REFUND OF DIFFERENCE IN REVISED PERMIT #92-008304 FOR 11603
1, the .undersigned do hereby
certify under penalty n
TOTAL
63.72 </
EAST GRACE AVENUE PER COPIES OF BOTH PERMITS ATTACHED
that funds have been
-
ORIGINAL PERMIT 153.00
+27.54 180.54
sufficient
budgeted for this claim, the ma--
terials have been furnished, ser-
vices rendered or labor performed
TRAVEL CERTIFICATION
I hereby certify under penalty of perjury
that this is a true and correct claim for
necessary expenses incurred by me and
REVISED PERMIT 99.00
+17.82
as described herein or contracted
for, that the claim 'is a just, due
and unpaid obligation against
that no payment has been received by me
on account thereof.
116.82
Spokane County or fund agency
SIGNED
DIFFERENCE 63.72
indicated above, that I am autho-
rized to authenticate and certify
TITLE
INTRA -GOVERNMENTAL VOUCHER
to said claim.\
.
DATE
SELLERS
ACCOUNT
DISTRIBUTION
BFFSET
EXAMINED and ALLOWED
FUND
AGENCY
ORGAN-
RATION
SUB
ORG
ACTIVITY
REVENUE
SOURCE
REV
SRC
JOB NUMBER
RR'r
CATEG
RECEIVABLES
ACCOUNT
I
�E \-.
-'"'CERT1FIGATT.ION ION \+
DATE 19
SIGNED --C.\} Y 1
CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
TITLE nrr T rr A f1MT NT CTD AT(
R MEMBER
rendered or the labor performed as described herein or contracted
for, and that the claim is a just, due and unpaid obligation, and that TITLE
I am authorized to authenticate and certify to said claim DATE
DATE 10/27/92
MEMBER
LT°
ib- .z/ -5L
(c.),46h, /2 /777 �GY�cE�Y j
Orr) c31 66. 24. eVZE-C1 VO
rhar+G'a#VS
6u,,✓'ls
/70 C✓�p cam_
SAaai,a . / hc.0a--airs -..G— l�GZ__
VOW .0 <_1 e f 4s7 -c L d f s1.24,0
.S'.cr `:na-O Of 6
/s‘ &?
KccJdriit �L/b
w -rd.
ethczo--4-
?0.6