1993, 08-03 Permit: 93006362 RefundPv# *
EPS PAYMENT DOCUMENT
SPOKANE COUN7ff AUDITOR
Dept _
VENDOR SH P M. Blu TO:
.. . # LENNARD As
3421 NORTH DICK ROAD
5POKANEt WA 99212
Vendor Contact/rel Coe n ing order
Change Order #.
Bid ID
Blanket#
RC# Pi'1, �nrsr 1
V[#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: ' i DELIVERY DATE: WAREHOUSE:
COMM LN# I DESCRIPTION
COMMODITY NO REP ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE
#9 3006 352 517 NORTH DICK ROAD
PIAN SIZE REVISED PER COPY OF PERMIT & NOTE TO FILE
00000000
PAGE TOTAL:
LINE NO. I FUND AGCY ORG SB ORO ACT OBI SB OBI REV SRC I SB REV I RPT CAT I BS ACCT TOB NO PAY THIS AMOUNT P/F
RECEIVING CERTIFICATION PAYMENT CERTIFICATION
Materials noted in quantity / have been I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the
received in good condition or contracted for. 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
SIGNED and certify to said claim.
TITLE SIGNED TITLE
DATE DATE
IICD A DTIACAIT 7
TRAVEL CERTIFICATION
1 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
•
'' .. A NOTE TO THE FILE
RE: Af s/2 ,0 te7V( / � DATE: - a 9-Z
jc /o G
/4.
STc,U - �v °v r)
S-
/�_ �� `By: G(