HomeMy WebLinkAboutInvoices - BOCC (002)- ----------
Form State of Washington
Al MIA INVOICE VOUCHER
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AGENCY USE ONLY
UaLq,
INSTRUCTIONS TO VENDOR OR CLAIMANT:Submit this form to claim
payment for materials, merchandise or services. I Show complete detail . for
each item.
Vendoes Certificate: I hereby certify under penalty of pejury that the Items
and totals listed herein are proper charges for materials, merchandise or
services furnished an for services rendered have been provided Without
discriminations because of age, sey., marital status, race creed, color,
national origin, religion, or Vietnam era or disabled veterans status.
(AWN IN IN;7
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(DATE)
FEDERAL I,D. NO. OR SOCIAL SECURITY NO, (For Reporting Personal S-erWcea- Contact Pa mems to I.R.S.)
RECEIVED BY
DATE RECEIVED
Od. 21
PROSECUTOR'S OFFICE
Kevin J. McCrae (KJM)
Data attached,
5.75 96.06
552.34
Debra L, Larson (DLL)
Data attached
3.00 41.94
125,82
Laura A. Hewitt
I LH)
Data attached
5.00 37.96
189.80
Daniel C. Crawford (DQ
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Data attached
.25 77.12
19.28
Geri L. Hinkle (GH)
Data attached
.25 47.12
11,78
Janet Millard (JM)
Data attached
3.25 56.11
182.36
Total
$ 1,.081.38
PREPARE.0 13Y
LEPHONE. NUMBER
DATE
AGENCY APPROVAL
DATE
DOCDATE
PMT DUE DATE
CURRENT I)OC N0.
REFK DOC. NO. VENDOR NUMBER
VENDORMES SAGE
USE TAX
UBI NUMBER
REF
DOC TRANS
S UF CODE
M
0
D
FUND
APPN PROGRAM
INDEX INDEX
$US
OBJ
SUB
SUB
OBJECT
ORO
INDEX
WORK C CITYfTOWN
LASS COU141Y
PROJECT
SUB
PROD
PRO,
PHAS
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AMOUNT
INVOICE
NUMBER
ALLOC BUDGET mos
UNIT
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ACCOUNTING APPROVAL FOR PAYMENT --
DATE
WARRANT TOTAL
WARRANT NUM. BER.