ENVH RefundHarnett
COUNTY
NORTH CAROLINA
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date: February 24, 2017
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00
Kimberly Galbreath
414 Mills House Lane
Spring Lake, NC 28390
7X Mail to payee
F] Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Reason for check request: Customer already has a well on the property and wants to use it instead of
creating a new well.
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
This instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal ControlAct
Harnett County Finance Director
Description
Amount
ENVH Well Fee
$ 250.00
Location : Lt. 2, 414 Mills House Lane
HTE # 17-5-40712
Total Amount Due
i
1 $ 250.00
Reason for check request: Customer already has a well on the property and wants to use it instead of
creating a new well.
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
This instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal ControlAct
Harnett County Finance Director