1992, 11-30 Permit: 92004231 Partial RefundSPOKANE COUNTY PAYMENT VOUCHER 132037
11/30/92
VENDOR REFUND
CODE
NAME Always Active
ADDRESS P. 0. BOX 141562
SPOKANE, WA 99214
DATE
AGENCY CODE ENFORCEMENT
NAME
AUDITORS STAMP
•
ACCOUNT DISTRIBUTION, ORIGINATING ENUTY
(ALL.VOUCHER TYPES)
• 1099 REO'D IDM
LINE
NO.
VENDOR'
INVOICE NUMBER
FUND
AGENCY
ORGAN -ACT
IZATION
OBJ
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
REPT
-CATEG
BS
ACCT
DESCRIPTION
AMOUNT
1
92-004231
406
030
0008
2210
02
REFUND
8.00
2
n
401
436
0000
4241
n32.00
•
DETAIL
DESCRIPTION
1 & 2 80% REFUND ONPERMIT #92-004231 FOR 1711 SOUTH MAMER ROAD
I, the undersigned do hereby
certify under penalty of perjury
TOTAL
40.00
PROJECT CANCELED
that funds have been
• -
-
sufficient
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
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
indicated above, that I am autho-
TITLE
INTRA -GOVERNMENTAL VOUCHER -
rized to authenticate and, certify
to said claim. s.
DATE
SELLERS ACCOUNT
DISTRIBUTION
�
FUND
AGENCY
ORGAN-
IZATION
SUB
ORG
ACTIVITY
REVENUE
SOURCE
SUB
JOB NUMBEROFFSET_
SRC
R('r
CATEG
RECEIVABLES
ACCOUNT
�\
EXAMINED and ALLOWED
N.
CERTIFICATIONS
DATE 19
\
_
SIGNED< -:"-----:\s, /
CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the Services SIGNED
OFFICE ADMINISTRATOR
TITLE
•
‘..
MEMBER
rendered or the labor performed as described herein or contracted TITLE
for, and that the claim is a due and unpaid obligation, and that
11/3U/92
fust,
I am authorized to authenticate and certify to said claim. DATE
DATE
MEMBER