1996, 04-10 Permit 96002054 Refund PaymentLGFS PAYMENT DOCUMENT
PV# SPOKANE COUNTY AUDITOR
Dept
VENDOR: Sw M. BILL TO:
Vendor CotdaoVTel Cordan®p Order
Change Onda #
Bid ID
Blanket#
RC#
VI#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE:
CO—MLN* DESCRIPTION
COMMODITY NO REF ACCT LINE QUANT17Y UNIT UNIT PRICE TOTAL PRICE
5, q «`I o'c L+
RECEIVING CERTIFICATION PAYMENT CERTIFICATION TRAVEL CERTIFICATION
Matenale noted in quantity V have been 1, the undendgmd do h mby cenify under penalty of perjury drat sufftlent funds have been budpred for rib's claim, the I hereby cemfy under "miry of "duty drat this
received in good oondidon or contnmd formaterials neve been funusred, services tendered or labor peffonned as described herein or conrnmd for, that me daim is a rinse and coned claim for noccemry a prmca
a jusC due and unpaid obligation apitut Spotem County or fund ageney iMinted above, that 1 em eud sonred In aur rmica a irmurred by me and drat no payment hers been received
SIGNED and certify to mid claim,cc by me on ecmunt tbereot
TITLE SIGNED TITLE i J J i tJ � Z tC� f SIGNED TITLE
DATE DATE DATE PAGE
DEPARTMENT2