1992, 09-01 Permit 92006474 RefundVENDOR
COI')E
NAME
SPOKANE COUNTY PAYMENT VOUCHER
REFUND
KIPEL CONSTRUCTION
ADDRESS 5708 NORTH MARKET
SPOKANE, . A 99207
NUMBER
DATE
131964
1/02
AGENCY
NAME
AUDITORS STAMP
ACCOUNT
DISTRIBUTION,
ORIGINATING
ENTITY
(ALL VOUCHER
TYPES)
• 1099 REQ'D ID#
LINE
NO.
VENDOR
INVOICE NUMBER
FUND
AGENCY
ORGAN-
IZATION
ACT
OBJ
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
REPT
CATEG
BS
ACCT
DESCRIPTION
AMOUNT
DETAIL DESCRIPTION
1 RED ON PERMIT #92-005474 PAYMENT ON lOu._' FAST- ,fEg or
I, the undersigned do hereby
certify under penalty of perjury
TOTAL
#8707 PER COPIES OF PERMIT & CHECK ATTACHE
that sufficient funds have been
CHECK #8707 54.00
8/25/92 PAYMENTW/RECEIPT #6920 —21,24
budgeted for this claim, the ma-
terials have been furnished, ser-
vices rendered or labor performed
as described herein or contracted
TRAVEL CERTIFICATION
I hereby certify under penalty of perjury
that this is a true and correct claim for
necessary expenses incurred by me and
REFUND DUE 32.76
for, that the claim is a just, due
and unpaid obligation against
Spokane County or fund agency
that no payment has been received by me
on account thereof.
SIGNED
indicated above, that I am autho-
rized to authenticate and certify
TITLE
INTRA-GOVERNMENTAL VOUCHER
to said claim.
DATE
SELLERS ACCOUNT
DISTRIBUTION
�l_�
FUND
AGENCY
ORGAN-
IZRGAN-ATION
SUB
ORB
ACTIVITY
REVENUE
SOURCE
SUB
REV
SRC
JOB NUMBER
CATEG.
RPT
OFFSET
RECE VABLES
ACCOUNT
EXAMINED and ALLOWED
DATE 19
GE TIFICATION
SIGNED
CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
the labor
TITLE F' ICE ADMINISTRATOR
MEMBER
rendered or performed as described herein or contracted TITLE
for, and that the claim is a just, due and unpaid obligation, and that
I am authorized to authenticate and certify to said claim. DATE
CI /1 /92
DATE' '
MEMBER