1996, 05-23 Permit: 96002327 RefundPV#
Dept
VENDOR
.+IK -m t DAVID
.4723 E RTVERSIs A,
W& 992:
LGFS PAMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Vendor Cordact/Tel Cotdatninq Order
BILL M.
Chanw Order #.
)fid ID
Blanket#
RC#_
VI#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE:
COMM LN# DESCRIPTION
COMMODITY NO REP ACCT LINE QUANT17Y UNIT UNIT PRICE TOTAL PRICE
PAGE TOTAL: 67.70
DISCOUNT TOTAL: 0.010
FREIGHT TOTAL: G.00
SALES TAX TOTAL: 0*00
"URCHASE ORDER VALUE: 67.70
Trt Y 7""T.l1
a
LINE NO. FUND AGCYI _ ORG I SB ORG _ ACT OBI SB OBI REV SRC I SB REV I RPT CAT I BS ACCT JOB NO. [PAY THIS AMOUNT P/F
RECEIVING CERTIFICATION
Materials noted in quantity V have been
received in good condition or contracted for
SIGNED q
TITLE 4
DATE 5/23/96
PAYMENT CERTIFICATION
1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the
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
and certify to said claim. _
SIGNED y TITLE lr T F ADMINISTRATOR
DATE 5/13-5-6 �.
DEPARTMENT2
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_
PAGE