HomeMy WebLinkAboutInvoices - BOCCForm ��9TAT,g0- State of Washington
A19 -1A w = INVOICE VOUCHER
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AGENCY USE ONLY
AGENCY NO, 4
,CA710N.CORE
P.R.•ORA(JTIi;IVO '=
0550
Barbara J. Vasquez
ADMINISTRATIVE OFFICE OF THE COURTS INSTRUCTIONS TO VENDOR OR CLAIMANT: Submit this form to claim
PO BOX 41172 payment for materials, merchandise or services. Show complete detail for
OLYMPIA WA 98504-1172 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
f services furnished and/or services rendered have been provided without
VENDOR OR C.LAItVANT VNairlrant �s to be payable to �. discriminations because of age, sex marital status, tatus, race creed, color,
* national origin, religion, or Vietnam er or disabled veterans status.
Grant County
PO Box 37
Ephrata, WA 98823 BY ,
XSVN IN-Hqmy' 24
M�x�
�
y Carter, BO C Chair
FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For Reporting Personal Services Contract Payments to I.R.S.) RECEIVED BY DATE RECEIVED
91-6001319
10/6/ Prosecutors Office
21 1
Reimbursement of Staff Hours - Code 40113
11/2/21 Prosecutors Office 1
Reimbursement of Staff Hours - Code 40113
October 2021
PREPARED BY
TELEPHONE NUMBER
DATE
Barbara J. Vasquez
509-754-2011 ext 2928
DOC DATE
PMT DUE DATE
CURRENT DOC NO.
REF. DOC. NO.
VENDOR NUMBER
REF
M
MASTER
INDEX
SUB
WORK CLASS
COUNTY CITY)
DOC
TRANS
0
FUND APPN PROGRAM SUB
SUB
ORG ALLOC
BUDGET M
SUF
CODE
D
INDEX INDEX_ OBJ
OBJECT
INDEX
UNIT
$1,592.61
$1,081.38
AGENCY APPROVAL
VENDOR MESSAGE JUSE TAX JUBI NUMBER
PROJECT I SUB PROD I PHOS I AMOUNT
DATE
INVOICE
NUMBER
ACCOUNTING APPROVAL FOR PAYMENT I DATE WARRANT TOTAL IWARRANT NUMBER