HomeMy WebLinkAboutInvoices - BOCC (003)Form
State of Washington
A19 -IA INVOICE VOUCHER
ADMINISTRATIVE OFFICE OF THE COURTS
PO BOX 41172
OLYMPIA WA 98504-1172
FEDERAL I.D.. NOSOCIAL SECURITY NO. (Fa Reporting Pearl 0'-n"* "a" I'
Services Cortract paymerlts to I
AGENCY USE ONLY
OFFICE
0550
'Data attached
3,25
INSTRUCTIONS TO VENDOR OR CLAIMANT., Submit this form to claim
payment for materials, merchandise or services, Show complete detail fQr
each 'Item.
Vendor's Certificat m I hereby certify under penalty of pe that the items
and totals listed herein are proper charges for materials, or
services furnished and/or services rendered have been provided without
discriminations because of age, sex, marital status, race creed, color.
national dgin, religion, or Vietnam era or, -disabled veterans status.
RECENED BY- -----
JDATE EQEIV—E—D--1
Nov. 21
OFFICE
'Data attached
3,25
96.06
312.19
Kevin J. McCrae (KJM)
Brandon K. Guernsey (BG)
Data, attached
.75
75.2-5
56.44
Laurak Hewitt (LH)
Data attached
4.00
381,90
155.60 ----- -
Chad A. Jenks (CAJ)
---
Data attached
- 1,00
1.00
2.00
77.89
84.30
55.82111,64
77.89
84.30
Edward A. Owens (EAO)
- ------------
Data attached
Camille Renken (CR)
Data attached
Janet Millard (JM)
Data attached
.25
56.11
14-03
Total
1.
812. 9
0
I
PREPARED BY....
TELEPHONE NUMSER
DATE
. ....
AGENCY APMVAL
"
.
DATE
r-= DATE
PMT DUEDATEE CURRENT DOC NO.
REF, DOC, No,
VENDOR NUMq Be' R.
VENDORMESSAG E
USE TAX Us( NUMBER
REF----- - - - ---------
DOC TRANS
0 FUND APPN SUB
VMK
SUB OR G A[W
COUN CiTYtTOWROL
PP W50T
SUB PROJ
AMOUNT
OF CODE,
0 INDE 'IND0B
EX j
08J C -CT INDEX
-11 1 1
I , ,
UNIT -]
'I
PROJ PKAS
INVOiCE
I NUMBER
ACCOUNTING APPROVAL FOR PAYMENT ... rATE WARRANT TOTAL WARRANT NUMBER