REFUND REQUEST Harnett COUNTY OF HARNETT
CONTY CHECK REQUEST FORM
NORIA CAROLINA
Account Number: 110-0000-322-30-01 X Mail to payee
Project Number: 1750042682 Check to be picked up by:
Vendor Name: ANDREAJ SAKOWSKI
Vendor Number: (Requires approval of Finance Officer)
Remittance Address: 938 Cokesbury Rd Approved: Disapproved:
FUQUAV-VARINA,NC 27526
Description Amount
Mechanical Permit Fees $60.00
•
Total Amount Due $60.00 \\`
Reason for check request: Wood Stove will not work in home
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
•
NARIETT COUNTY CASH RECEIPTS
aw COSTAR RECEIPT mea
Date: 1/6j/l7 53 Receipt no:
:ra133634
Year Number Amount
2817 561142662
91755 TECH 3
LID1 SP
BP 27�1T FEES
668.68
ANDRZEJ SAAIINSKI
Tender detail
CP CRED1T CARD
Total tendered �.H
Total payment
Trans date: I1/8I/17 Time: 12:25:26
as MAW YOU FOR YOUR PAYMENT as