HomeMy WebLinkAboutInvoices - Renew (002)Form
State of Washington
A19-1AN ZIJ Invoice Voucher
Health Care Authority
621 8th Avenue SE
Olympia, WA 98504
Grant County
840 E Plum St
Moses Lake, WA 98837
TAX IDENTIFICATION NUMBER MONTH EAR OF SERVICE (MMlYYYY) RECEIVED BY
**-***I - 319
Sep -21
PROGRAM ACTIVITY khiitCSAP STRATEGY
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11.1 Admin/Indirect
122.10
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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 to the State of Washington ridthat a goods furnished and/or services rendered have been provided Without discrimination because
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Cindy Carter, BOCCChair Jt
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(date)
DATE RECEIVED
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REPARED BW DATE
TELEPHONE
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Reyna Gonzales 11/2/21
--1509 764-2660
CURR DOC II
DOC DATE -
AGENCY APVKUVAL:
SVVV0002426-00
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i� __ __ Sarah Marlani, 360-725-9401, Sarah.MarianiCcD_hca.wa.aov
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GRANT COUNIN