1999, 06-04 Permit: 99004583 Refund_ F LFLNL,
V# � -ap v C t : y
)ept
1 PLF;t�'
ENDOR:
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1 t: Tf�: N1 Av_.
rC.KA%- WA
'endor ContactITel
YOB:
ACCTG. PERIOD:
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO: BILL TO:
PO DA'L'E:
DELIVERY DATE:
Confirming Order
BLDG/ROOM:
WAREHOUSE:
Pv
Change Order # _
Bid ID -
Blanket#
RC#_____
VI#
MVCIbC 39(;01 I
LA G. KOVA
11,01,11 CVj�t..PEY (5) PERMITS
PERMIT # 99004581
35.UG
99004582
99004583
99004584
99004587
FAGt
DISCCUNT
TOTAL:
TOTAL:
35.06
C.C,C;
FREIGHT
TOTAL:
C.00
SALES TAX
PURCHASE CREEP
TOTAL.:
VALUE:
C.C;G
35 -CO
USE TAX
TOTAL:
G-00
GRAND
TOTAL:
35.(')U
i
- - .ri.. n�, fs nt,v liY"J' 'AT
BSA T B N PAY THI
AM UNT
35 -CO
'I{IVIN(' l' slt"1'Ihl('A'1'1(>N
I'A1' " Ch;It'1'IFI 'q'1'ION
TOTAL TO VENDOR:
35.CG
rials nut I , lu:unity have been
vcd in
1, the undersigned eb \Certify
a der penalty of perjury ihnl sul7ident funds have been budgeted for
'1'RAVM;h CERTIFICATION
x"I xlition contracted for
muterl s have been furnish{ ` ervic
this claim, the
rendered or labor performed as described herein
certifypenalty of
lu
a Just, du and unpaid oblignlio
or contracted for, that the claim is
Inst Spokane Counly or fund agency indicated above, that 1 am authorized to
is true and correcct claim for ner ceesrsary expenses
—
— nntl certify 1 said claim.
aulhenticnle
Incurred by me and that no payment has been received
A CT TE H 3
by me on account thereof.
I; -
Sl(;Nl:l) ,
OFFICE ADMINISTRATOR
rrrl.l:
6/4/99
'6/4/99
_ -
suiNl;n rrrl.E
_
DATE
I )ATE
PAGE
iai;COUNTS PAYAEL I-*
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