HomeMy WebLinkAboutReimbursable Work Request - GRISi i
Farm +.. Stare of Waahinglon
AIo-IA Invoice Voucher
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^°'"""° AgreemeatlDor ConaaclN-doer
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AGENCY NM/E
HeallhCan Atlthorlly _ _ _ _ _- _ - - .
PO Box 42691
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Olympia, WA 98504-2691
VI;N000.0x CIMIANT
Grant County - _
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Moses LaStreet:
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V.rdrea Canificate. I hall, carafy under penally of perjury Nat the ilems and totals listed Wainer. proper charges for metenals, merchandise or services furnished
,-' - 'se of age, seat, manlal :1aN: race creed color , nanonr
Washington and metvlall goods fumtshed and/or services re eerAChpva Bean pro w thwt d,-'[',,
_ nanaicap religion or emam arawe'eahtaa re sta s
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Carter BOCC Chair
to the Slate of
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TAX IDENTIFICATION NUMBER MONTHIYEAR OF SERVICE
91-6001319 ton 1201 B Supplemental #1
RECEIVED BY DATE RECEIVED
eARa GROGRAM ACiIVIIY NAME C-lTMTEOY
IOM
lAGG GFS Gr9 NCE PF8101a OMA aTR NCE 9OR 8011 Gepp
EBG PP Gar -
Total
11.1 Admin
0 00 0.00 0.00 O.Oo 000
0.00
21 Community -Based Coordination-Px CommunilyBased Process
Univeraal-Indirecl
22.5 Community Coaftion Coord'utator Community -Based Process
Universal -Direct
0.00
2205 Community Coalition Community -Based Process
Universal -Direct
0.00
4451 Community Coalition Coord'nalor-ML Community -Based Process
Universal -Direct
2451 Community Coalition./Supplies -ML CommunityBased Process
Universal -Direct
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
22.5.1 lCminunityCoalitionCoordhator-Quincy Cernmuniy-BasedProceaa
Univarsal-Dira1
0.00
22.5.1 CommunilyBased Process
UniversaFDinect
1
0.00
0.00
22.1.1 Information Dissemination
Univeraal-Direct
0.00
0
0.00
2211 °'^^•• "" ''M"v'^v'•""•"iOr"`r Information Dissemination
Universal -Direct
0.00
22.2.1 s"i"n"^'"a r.m"" `•s"i°"M"E "'"av""'a"""'' Education
Univemal-Direct
0.00
22.3.1 Healthy Alternative Activities -5th ORT -Quincy Alternatives
Universal -Direct
0.00
0.00
0.00
0.00
0.00
0.110
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
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PREPARED BY/DATE
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Reyna OonaNs ]/t&20
TELEPHONE
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A19 Effective 711119 through 6130121 REVISED 7118119
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CURR DOC NO
DOC DATE
VENDOR NoAGENCY
APPROVAL:
Sarah Marlanl 360-725-9401 Sarah.Mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
1 I I Blender Gonadal Page t R- /-t LB