ENVH RefundHarnett
COUNTY
li;' ?p r.hpC'i i N A
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number:
110-0000-345.18-00
Project Number:
Vendor Name:
Wayne Rambeaut
Vendor Number:
Remittance Address:
330 Ayrshire Court
Fayetteville, NC 28311
Mail to payee
FICheck to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Description Amount
Return trip fees for ENVH 2 @ 25.00 each $ 50.00
Total Amount Due $ 50.00
Reason for check request: Oliver Tolksdorf waived return trip fees on two lots for soil evaluations because return
trip was not necessary on these lots.
Kenlan Farms Lot 24 app# 10-5-25081
Kenlan Farms Lot 25 app# 10-5-25082
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee Date
This insturment has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director