ENVH REFUNDHarnett
fOUNTY
NORTH CAROLINA
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date: July 6, 2012
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00
Jared & Melissa Pollino
406 Knightsborough Way
Apex, NC 27502
❑X Mail to payee
1-1 Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Description
Amount
Existing Tank Inspection Fee
$ 100.00
Application #12-5-29170
East Mill S/D Lt 7 - Hwy 42
Total Amount Due
$ 100.00
Reason for check request: Above listed applicants changed their mind and decided not to proceed at this time.
No site visit performed prior to this notification
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee Date
Graham H. Byrd, R.E.H.S. m
This ' rument has been
preoudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director