HomeMy WebLinkAboutInvoices - BOCCForm State of Washington
A19-1A INVOICE VOUCHER
AGENCY USE ONLY
-- :
AGE�NO-LOCATION CODE P -R.;OR
0550
AGENCY:NAME
INSTRUCTIONS TO VENDOR OR CLAIMANT: Submit this form to claim payment for materials, merchandise or
services. Show complete detail for each item.
Vendor's Certificate: I hereby certify under penalty of perjury that the items and totals listed herein are proper charges
materials, merchandise or services furnished and/or services rendered have been provided without discriminations
because of age, sex, marital status, race creed, color, national origin, religion, or Vietnam era or disabled veterans
status.
BY
(SIGN IN INK)
(TITLE) (DATE)
ADMINISTRATIVE OFFICE OF THE COURTS PO BOX 41172
OLYMPIA WA 98504-1172 Ifor
VENDOR `011,'CLAIMANT
7
Grant County
PO Box 37 Ephrata, WA 98823
FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For Reporting Personal Services Contract Payments to I.R.S.)
91-6001319
RECEIVED BY
DATE RECEIVED
E S C � - R- 1 '01, ION
E
-z�
FOR' AGENCY -.--
2/1/2022
Prosecutors Office
1
$1322.68
Reimbursement of Staff Hours - Code 40113
Dec-21
Clerk's Office
1
$317.80
Reimbursement of Staff Hours - Code 40113
Dec-21
Clerk's Office
LFO refunds for December - CODE 40 100
1
$2,476.48
Total
$4, 116.96
PREPARED BY
Barbara J. Vasquez
TELEPHONE NUMBER
509-754-2011 ext 2928
DATE
AGENCY APPROVAL
DATE
DOC DATE
PMT DUE DATE
CURRENT DOC NO.
REF. DOC. NO.
VENDOR NUMBER
VENDOR MESSAGE
USE TAX
UBI NUMBER
REF
DOC
SUF
TRANS
CODE
M
0 D
FUND
A STERINDE
APPN PROGRAM
INDEX INDEX
SUB
BB
SUB
SUB OBJECT
ORG
INDEX
WORK CLASS
COUNTY
CITY/TOWN
PROJECT
SUB
PROJ
PROJ
PHAS
AMOUNT
INVOICE NUMBER
ALLOC
BUDGET
UNIT
MOS
ACCOUNTING APPROVAL FOR PAYMENT
DATE
WARRANT TOTAL
WARRANT NUMBER
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