HomeMy WebLinkAboutInvoices - BOCC (002)Form -VA .0 State of Washington
A19 -IA
INVOICE VOUCHER
AGENCY USE ONLY
0550
77 -
INSTRUCTIONS TO VENDOR OR CLAIMANT: Submit this form to claim
payment for materials, merchandise or services. Show complete detail for
each item.
VendoesCertificate: I hereby cerfify 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 Vietnam era or disabled veterans status,