1999, 05-12 Permit: 99003898 Refund. 11 1 I
Dept ----
L 1 N
VENDOR: SHIP TO:
13ANA L AN 5i 14
NV n 4—Iq
Vendor Contact/Tel
FOB: PO DATE:
ACCTG. PERIOD: / DELIVERY DATE:
RFCFIN'I
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SPOKANE COUNTY AUDITOR
BILL TO:
Confirming Order
BLDG/ROOM: BUYER
WAREHOUSE:
SLC K S T A D T PURCHASI�C DIF
PITY UNIT
CE
QVERPDt P*.J:r' 99-3,Q;98
SITE: 3112 N. PARK Rd, Spokane WA 99212
P"J-
SITE: 21725 E. WELLESLEY #17, Otis Orchards WA 99027
IND I AGCY ORG J SB ORG I ACT I OB1 I SB OB1 i REV SR
` S �U 1 ,v
4 5 C 30 6981
5981
-"ATION PAI'M FNT
✓ have been 1, rhendersigned do I
Spec trr materia a hove been fu
a just, dr and unpaid
end certify o said clan
PAGE TOTAL:
DISCOUNT TOTAL:
FREIGHT TOTAL:
TAX TTAL:
PURCHASEEORDER VALUE:
USE TAX TOTAL:
GRAND TOTAL:
:)T CAT IR(i ar t --r ,,.,... .
under enalty of perjury that sufficient funds have been budgeted for this claim, the
•es ren ered or labor performed as described herein or contracted for, that the claim is
at pokane County or fund agency indicated above, that I am authorized to authenticate
TECH IsIcif J
CNED_ TITLE OFFTrp. ADMINTSTR1
DATE_/2/99 DATE 5/12/99
ACCOUNTS PAYABLE
TOTAL TO VENDOR:
12.00°
12.00
�T
k
24.00
0.00
0.00
0.00
24.00
0.00
24.00
=
12.00
12.00
P4. nn
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 1