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<br /> - <br /> ~ Pay to: (Nama, Add,. _ City, Slato, Zip) <br /> PURCHASE VOUCHER (CIty County 'Schoo I ect...l <br /> ARK.TEX COUNCIL OF GOVERNMENTS <br /> P.O. 60x 5307 <br /> Toxari<ana. TX 75505-5307 , <br /> (Submit in Triplicato) ~Conl'aCl 0' Gram No: ~ Vendor No: <br />c!. Dol",Il'" Data:?oriod and Doscription,gl Anlclu 'Ol'Sorvlees'Provided:t> >':.e. ~&.;h~t"~}:~~.,'..~: .:t.'ioi.~:<<;J~./':r-&,1"':~f ::::a.'~i-<:,iIi"*~{,l< .':'<';?:""~~,;':"~ <br />Paymom Porod: <br />-2./-1/.2.2. to ..~..J_1.L.22 Amount Due <br />For reimbursement for the activities under the <br />Ark-Tax Counc i I of Governments Regional Solid <br />\/osta Monegement PI en Pass Through Grants as <br />funded by the Texes Natural Resources Conservation <br />Con\'lll ss i on <br />Cummuletive expenditures to date 2,500.00 <br />Less on PrIor Requisition ..0- <br />Due this voucher I 2,500.00 , $2,500.00 <br />Contract amount $7,500.00 <br />Expended to dote 2,500.00 <br />Bolonce remelning $5,000.00 <br /> S ample 0 c rler <br /> -'< $2,500.00 <br /> h. VOUCHER TOTAL ... <br />~ I eonC1y tha1 th; above nrvicos/goods wlr. Signature - Vendor RClpreslntativ.: Tolophono No: <br />rtnderodtreotivod. and thll thO,. correspond In <br />,".ry way with the contrld und.r which they were 11110: Data: <br />procurod and thaI tho Invoice is trUI and unnaid. <br /> ATCOG Dat' ~prov.d tor Payment: ATCOG DISTRIBUTION ACCOUNT AMOUNT <br />APPROVAL <br />FOR PAYMENT <br />S~nC!ur.: <br />TrJo: 1 <br />Environmentol Resources PI anner <br />S"Qnatut.: <br />Tnlo: <br />Director, Reg i one I Services <br />V.r<ior No: Cod~ by: Chock No: . ' Oalo: , Aniount <br />