ENVH REFUNDNORTH CAROLINA
Account Number
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date 03 -10 -14
X9I WK8I2 _ : ► ■ .
110 - 0000 - 345.18 -00
Mary Blue
P O Box 2642
Lillington, NC 27546
Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Reason for check request: Mary Blue requested a refund because she is not going to place the SWMH 14 x80
in he park. No site visit has been made from Environmental Health.
This check request has been examined by me and is hereby approved for payment.
Department Head or,Apthorizecl Designee Date
Graham H. Byrd, R.E.H.S.
his ' trument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
Existing Tank Fee
$ 100.00
Application # 14 -5 -33036
Location : Pine Forest MHP - 10 Privette Lane
Total Amount Due
$ 100.00
Reason for check request: Mary Blue requested a refund because she is not going to place the SWMH 14 x80
in he park. No site visit has been made from Environmental Health.
This check request has been examined by me and is hereby approved for payment.
Department Head or,Apthorizecl Designee Date
Graham H. Byrd, R.E.H.S.
his ' trument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director