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<br /> 1!::il Pay to: (Name, Add,. . City, State,~) <br />" PORCHASl:VOUCHER (City ~ounty '"Schoo I ect. . . ) <br />ARK.TEX COUNCIL OF GOVERNMENTS - <br /> -~ <br /> . .' - ", <br /> P.O. 90x 5307 <br /> Tax8lkana, TX 75505.5307 I.:!!d Contrad or Grant No: ~ Vendor No: <br /> (Submh In Triplicale) <br />',4, >-Oeliverv DataIPeriod and Detcription 1:11 Mlclesor:ServlcnPlOvidecH., .~:.a.~~:rt-.:::f"~ ;,:L'i:O:~l:i.<=.t.)::;~~f;:'M : ::Ci'J;:~ ~4\:ff~1:'t:~:::?~:~.i~:.'~'~~':~~'~':'::':~:: <br />Payment Period: <br />..&!....JJ.22.. to ...V...1J~ Amount Due <br />For reimbursement for the ectlvltles under the <br />Ark-Tex Council of Governments Regional Solid <br />Waste Management Plan Pass Through Grants as <br />funded by the TeXas Natural Resources Conservation <br />Commission <br />Cummulatlve expenditures to date 2,500.00 <br />Less on Prior Requisition -0- <br />Due- th I,s voucher ':" 2,500.00 $2,500.00 <br />Contract amount $7,500.00 <br />Expended to date 2.500.00 <br />Balance remaining $5,000.00 <br /> ," sample 0 c er <br /> , ' <br />, .' ~- . - . <br /> .' - 1,["Z,:\iOUCHER~6TAL:>J;\i <br /> $2,500.00 <br />~ I eartify Ihal the above servicaslgoods were Signalure - Vendor Representative: Telephone No: <br />r8nderadlraoalvad. and thai thay correspond in . <br />every way with the contra~ under which thay were TItle: Date: <br />orocurad andlhat the Invoice is lrue and unpaid. __. <br />ATCOG Date Approved lor Payment ATCOG DISTRIBUTION ACCOUNT AMOUNT <br />APPROVAl:" ' " ,.' <br />FOR PAYMENT , <br />SignatUr8: <br />Tille: <br />Environmental Resources Plllnner , . k <br />Signatura~ , <br />Tille: <br />Director, Reglonlll'Services <br /> . <br />Vendor No: Coded by: Check No: Date: Amount: <br /> . <br />