REFUND Harnett COUNTY OF HARNETT
COUNTY CHECK REQUEST FORM
NORTH CAROLINA
Account Number: 110-0000-322.30-01 n Mail to payee
Project Number: 4270 Check to be picked up by:
Vendor Name: Roger Chavis
103 Twin City St
Dunn, NC 28334
16-50038472
Description Amount
Citizen is not $ 105.00
adding these permits
16-50038472
Plumbing$50.00/Insulation$55.00 `,�
Total Amount Due $ 105.00 (J
CY.Y
-
Reason for check request: \\
Please add note in red to refund check******
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
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