1991, 10-28 Permit: 91007035 RefundVENDOR
CODE -
NAME `ALCO CnPDEN CENTER, INC.
ADDRESS 'RAGUE AVENUE
SPOKANE, WA 99205
SPOKANE COUNTY PAYMENT VOUCHER
.INE VENDR NO. I INVOICE NUMBER I FUNDI AGENCY I IOZATION I ACT OBJ I SUB OBJ I SOU CE I REB NUMBER RE f REPT
CA EG I ACCT
,I nn'7rl^
1 100% REFUND ON PERMIT #91007035 FOR 1004 (NORTH PIERCE ROAD
DUPLICATE PERMIT PER COPY OF PERMIT AND PERMIT #91002400
ATTACHED
FUND AGENCY' ORGAN- I 8U8 I ACTIVITY I REVENUE I REv I JOB NUMBER I RPT. I REC;Z LES
IZATION ORG SOURCE cart CATEG. Accni INT
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
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
12934
DATE 10/28/91.
AGENCY `ODF ENFORCEMENT
NAME - - - --
AUDITORS STAMP
❑ 1099 REQ'D ID#
DESCRIPTION
?F=UND
I, the undersigned do hereby
certify under penalty of perjury
that sufficient funds have been
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
indicated above, that I am autho-
rized to authenticate and certify
to said claim.
CERTIFICATION
7
SIGNED
Tr
TITLE
10/28/91
DATE
AMOUNT
35.00
36. OU
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
EXAMINED and ALLOWED
DATE 19
CHAIRMAN
MEMBER
MEMBER