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Form ��� STAT$v� State of Washington
A19 -1A w� s�. INVOICE VOUCHER
ADMINISTRATIVE OFFICE OF THE COURTS
PO BOX 41172
OLYMPIA WA 98504-1172
* 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
1-1/20 Prosecutors Office
21 Reimbursement of Staff Hours - Code 40113
November 2021
Clerk's Office
Reimbursement of Staff Hours - Code 40113
Clerk's Office
LFO Refund - Code 40100
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AGENCY USE ONLY
„ AGENCY, NO LOCATION CODE PR OR AUTH NO '
0550
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 for 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 Vietna a or disabled veterans status.
BY
("indyCarter.010CC Chair t2-,ZF--21(
RECEIVED BY I DATE RECEIVED
$812.09
$1,902.33
$11,481.59
PREPARED BY
Barbara J. Vasquez
TELEPHONE NUMBER
DATE
AGENCY APPROVAL
DATE
509-754-2011 ext 2928
DOC DATE
PMT DUE DATE
CURRENT DOC NO.
REF. DOC. NO.
VENDOR NUMBER
VENDOR MESSAGE
USE TAX
UBI NUMBER
REF
M
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INDEX
SUB
WORK CLASS
COUNTY CITY/TOWN
DOC
TRANS
O
FUND
APP PROGRAM SUB
SUB
ORG
ALLOC
BUDGET MOS
PROJECT
SUB
PROJ
AMOUNT
INVOICE
SUF
CODE
D
INDEX INDEX OBJ
OBJECT
INDEX
UNIT
PROJ
PHAS
NUMBER
ACCOUNTING APPROVAL FOR PAYMENT DATEWARRANT TOTAL WARRANT NUMBER