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<br />I <br />PURCHASE VOW~l.fER <br />ARK.TEX COUNCIL OF G~ .RNMENTS <br /> <br />[B Pay to: (Nai,,~. Address~City. Stat;"Zip)--- --- <br />( C t ty Co u n t y .', 00 I e ct. .. ) <br /> <br />. <br /> <br />-- <br /> <br />.. .', <br /> <br />.' '.' ." <br /> <br />P.O. Box 5307 <br />Texar1<ana, TX 75505.5307 <br />(Submh In Triplicate) <br /> <br />~ Contrad or Grant No: <br /> <br />~ Vendor No: <br /> <br />I <br /> <br />.d. . DelivervDatelPeriod and Description of Articles or Services Provided :.~ ~.. "....:.."... <br />Payment Period: <br />~_1J.2i to ..2.LlJ..22 <br /> <br />:.: I.. ,,':::>~:~:~:~:' ~:;::::;,' .;::~::f:':.:: \~:: :::' a ~ ;",,;.;:: :/: :::~~;:;:::::i~~::1'::::.: .:: ,V::';:;',:;::::. :" >~: ::t~::~~;:J:: <br /> <br />Amount Due <br /> <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 Texes Nature I Resources Conservetlon <br />Convnlsslon <br /> <br />Cummuletive expenditures to dete <br />Less on Prior Requisition <br />Due this voucher <br /> <br />2,500.00 <br />-0- <br />2,500.00 <br /> <br />$2,500.00 <br /> <br />Contrect amount <br />Expended to dete <br />Belance remeinlng <br /> <br />$7,500.00 <br />2,500.00 <br />$5,000.00 <br /> <br />i <br />I' <br /> <br />sample <br /> <br />o c~er <br /> <br />.JJ I certify that the above services/goods were <br />rendered/received. and that they correspond in <br />every way whh the centrad under which they were <br />procured and that the Invoice is true and unpaid. <br />A TCOG Date Approved for Payment: <br />APPROVAL <br />FOR PAYMENT <br />S~nature: <br /> <br />h.-VOUCHER TOTAL':: ...:.: $2,500.00 <br />Signature - Vendor Representative: Telephone No: <br /> <br />Title: <br /> <br />Date: <br /> <br />ATCOG DISTRIBUTION ACCOUNT <br /> <br />AMOUNT <br /> <br />Title: <br />Envlronmentel Resources Plenner <br /> <br />S~nature: <br /> <br />Tnle: <br />D I rector, Reg i on81' Serv t ces <br /> <br />" <br /> <br />Vendor No: <br /> <br />Coded by: <br /> <br />Check No: <br /> <br />Date: <br /> <br />Amount: <br /> <br />\ <br />! <br />