1996, 11-21 Permit: 96004172 RefundREFUND
Pv# MV112060012
Dept F O R C E
VENDOR: SHIP TO:
STURM HEATING
204 E INDIANA AVE
SPOKANE WA 99207
Vendor ContacVTel
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Confirming Order
BILL TO:
PV —
Change Order #
Bid ID
Blanket#
RC#
VI#
MV11206001�
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: 11/96 DELIVERY DATE: WAREHOUSE:
FRED BY: PATRICIA E I C K S T A DT PURCHASIN DIRECTOR: DONALD L+ LA BR EC QLJE
- fOMMOD CT LINE -QUANTITY - _SNITR� ICE__- - TOTAL PRICE -
80%t PRJ#96-41721 CANCELLED
SITE: 17718 E. MONTGOMERY AVE
GREENACRES WA 99016
01 406 030 0008
RECEP✓IN RTIFICATION
Materig,.quanti ✓have toren
receiveonditi r contracted for.
SIGNE
TITLE Fl C I
DATE 11/21/96
38.40
PAGE
TOTAL:
38.40
DISCOUNT
TOTAL:
0.00
FREIGHT
TOTAL:
0+00
SALES TAX
TOTAL:
0.00
PURCHASE ORDER
VALUE:
38+40
USE TAX
TOTAL:
0e00
GRAND
TOTAL:
38+40
2210 07 38.40
PAYMENT TMCATION
I, th ndersign by certify under natty of perjury that sufficient funds have been budgeted for this claim, the
me n h services rend red or labor performed as described herein or contracted for, that the claim is
a j ue and unpaid sins kane County or fund agency indicated above, that I am authorized to authenticate
and o
SIGNED E OFFICE ADMINISTRATOR
DATE 11[21/96 \
ACCOUNTS PAYABLE
TOTAL TO VENDOR: 38.40
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
1
DATE PAGE