1996, 04-30 Permit: 95009221 Refundr(rFJN:
Pv#
Dept L.. - CCOF NcORC:
MV(4296')L19
VENDOR:
COLE COISTRJCTICN
2713 = .,GJfi`_ AVEf,JE
SPG<ALE AA 992,2
Vendor Contact/To/
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
sin
TO:
Confining Order
BILL TO:
PV
MVO -74.96301i
Omngo Order #
Bid ID
Bla hurt#
RC#
VI#
FOB:
ACCTG. PERIOD: 34/90
COMMENTS.
PO DATE: BLDG/ROOM:
DELIVERY DATE: MARCIA +A.0 oAh RS(oL HOUSE:
FNTRRFI') RY
BUYER
PURCHASINf flIRFCTOR 3J,i4L3 L. LA'REC yIJE
COMM LN#
DESCRIPIPION
COMMODITY NO 1 REP ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
PtRMIT 95009241 - VOI.;ED
80; ReFJ\D 7202 c UTA
PAL_ TOTAL:
JISCJUNT TOTAL:
FRcISNT TOTAL:
SALES TAX TO'AL:
PURCHASE ORDER VALJE:
J5- TAX TOTAL:
°RAN.) TOTAL:
v.5)
.5.43
0.0J
O.CJ
3.OJ
65.46
3.03
65.4h
LINE NO.
FUND I AGCY
ORG
SB ORG
ACT
081
SB OBI
REV SRC
SB REV
. RPT CAT
BS ACCT I 108 NO.
PAY THIS AMOUNT
P/F
'.1
4C6 030 C0Od
02 N20 673
2210
32
37.10
TOTAL TO VENDOR:
60.98
4.J
05.43
RECEIVING CERTIFICATION PA CERTIFICATION
Materials noted in quantity / have been I, the .•Fersigsed do hereby ceruty under penalty of perjury that sufficient funds have been budgeted for this daim, the
received in g dfor. m.: ds b.ve been furnished services rendered or labor performed as described herein or contracted for, thartbe claim is
_ due ming unpaid obligati �n •pint Spokane County or fund agency indicated above, that I am authorized to authenticate
SIGNEIy// //J/1��2' a• adift m�' d claim V ,� ,,',,_.�
TITLE
SIGNED /IIi(r 'f1 \`t/V "' TITLE ASST DIRECTOR
DATE DATE 4 4/30/96
DEPARTMENT2
TRAVEL CERTIFICATION
1 hereby certify under penalty of perjury that this
is a true and correct daim for necessary expenses
incurred by me and that no payment has been received
by me on account thereof
SIGNED TITLE
DATE PAGE
1