ENVH RefundHarnett
COUNTY
NORTH CAROLINA
Account Number
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date: May 4, 2016
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00
Lorena Herrera
116 Hunter Field Drive
Sanford, NC 27332
FX Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved:_ Disapproved:
Reason for check request: Fee collected in error. Customer has public sewer no septic tank.
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee //�//,1 /•f/ Date
Graham H. Byrd, R.E.H.S. eAz— .6.� ✓ ' �-/ 7
s instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Existing Tank Fee
$ 100.00
HTE #16-5-39439
Carolina Hills Lt. 61
Buffalo Lake Road
Total Amount Due
$ 100.00
Reason for check request: Fee collected in error. Customer has public sewer no septic tank.
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee //�//,1 /•f/ Date
Graham H. Byrd, R.E.H.S. eAz— .6.� ✓ ' �-/ 7
s instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director