1990, 06-28 Permit 90002927 Refund VoucherVENDOR
CODE
IS PERIAL DATA SUPPLY 1-W0-541-5926
SPOKANE COUNTY PAYMENT VOUCHER NUMBER 57717
NAME CHARLES RADER
ADDRESS E. 11920 MANSFIELD AVE #026
SPOKANE, WA 99206
DATE 6/ 28/ 90
AGENCY BLDG&SAFETY
NAME
AUDITORS STAMP
ACCOUNT DISTRIBUTION,
ORIGINATING
ENTITY
(ALL
VOUCHER
TYPES)
• 1099 REQ'D ID#
LINE
NO.
VENDOR
INVOICE NUMBER
FUND
AGENCY
ORGAN-
RATION
ACT
OBJ
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
KEPT
CATEG,
BS
ACCT
DESCRIPTION
AMOUNT
1
BLDG&SAFETY
406
030
0008
2210
07
REFUND
$35.00
DETAIL DESCRIPTION
REFUND 100% OF PERMIT #90-2927, E. 11920 MANSFIELD
I, the undersigned do hereby
certify under penalty of perjury
TOTAL $35.00
that sufficient funds have been
AVE. GAS PIPING PERMIT NOT NEEDED.
budgeted for this claim, the ma-
terials have been furnished, ser-
vices 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
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
am autho-
rized to authenticate and certify
TITLE
INTRA-GOVERNMENTAL
VOUCHER
to said claim.
DATE
FUND
AGENCY
ORGAN-
RATION
SUB
ORG
SELLERS
ACTIVITY
ACCOUNT
REVENUE
SOURCE
sue
REV
SRC -ACCOUNT
DISTRIBUTION
JOB NUMBER
RPr
CATEG.
OFFSET -
RECEIVABLES
EXAMINED and ALLOWED
CERTIFIC TION
DATE 19
4 Wati{'
CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
rendered or the labor described herein
f
TITLE DIRECTOR
MEMBER
performed as or contracted
for, and that the claim is a just, due and unpaid obligation, and that TITLE
I am authorized to authenticate and certify to said claim. DATE
DATE 6 / 2 8 / 9 0
MEMBER