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<br /> &!iJ Pay \0: (Naml, Addrl: "I1y, Slall, Zip) <br /> PURCHASE VOUCh.,R (City County 'School .ct...) <br /> ARK.TEX COUNCIL OF GOVERNMENTS <br /> , <br /> P.O. Box 5307 <br /> Tenrkene, TX 75505.5307 ~ Contrael or Grant No: <br /> (Submh In Tripllcatl) ~ Vendor No: <br />cI. . Delwerv DatelPeriod end .Dllcription.of .Anh:I......S.rvIonf!lOvidad$ ~;...~ft..;~f$)::Ii;~-w* ,.:.L'~~~~.lfJ;/~:~..;,~t :~:a.;..j.;(' !it::t~;%,j~,~'_~;""';' 1:. _ ~.'~~:1'~..:~ <br />Payment Period: <br />_~LJ-'.2i.lo _2.-'..1/~ Amount Due <br />For reimbursement for the actIvitIes under the <br />Ark-Tex Counc II of Governmants Raglonal Solid , <br />W.ste M.nagement PI an Pass Through Grants as <br />funded by the Texas Natural Resources ConservatIon <br />Convnlsslon <br /> , <br />CUlMlulatlve expendItures to date 2,500.00 , <br />Less on Prior Requisition -0- <br />Due this voucher ! 2,500.00 $2,500.00 <br /> '! <br /> - <br />Contract amount $7,500.00 <br />Expended to date 2,500.00 <br />Balance remainIng $5,000.00 <br /> sample 0 c 1er <br /> ~~oUCHERT6TA.L .. . ">"~, $2,500.00 <br /> "+ <br />W I conity that tho above sorvj"".Jgood. were Signature - V.ndor Representativ.: , T ellphone No: <br />rondoredhecawod, and thaI they c:orrllpond In <br />every way whh Ih. contrael under which they were Thlo: Dale: <br />procured and that the Invoice is true and unpaid. <br /> AlCOG DOl. Approvod lor Peym.nt: ATCOG DISTRIBUTION ACCOUNT AMOUNT <br /> APPROVAl <br /> FOR PAYMENT <br />Signature: <br />TllIo: j <br /> . <br />Environment. I Resources Planner <br />Signaturo: <br />1410: <br />Director, Reg I ona I' Serv 1 ces <br />Vondor No: Cod~ by: Check No: . . Dati: ArIiount <br /> , <br /> . <br />