RefundHarnett
C O U N T Y
_.. NJRTH CAROLrNA
Harnett
COUNTY
CAROLINA
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number:
110-0000-345.18-00 EH
Project Number:
Vendor Name:
Red Door Homes
Attn: Allen Colglaizer
Remittance Address:
4002 Fayetteville Rd
17-5-42462R- Raynor MCLamb Rd
Raeford, NC 28376
Date:
6/12/2018
Division of Environmental Health
www.harneft.org
Harnett County Government Complex
307 W. Cornelius Harnett Boulevard
Lillington, NC 27546
❑X Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
ph: 910-893-7547
fax: 910-893-9371
Reason for check request: Homeowner changed his mind about doing the shop on the revision. See attached email.
This check request has been examined by me and is hereby approved for payment.
Head or Authorized Designee
. R.E.H.S.
This instrument has been
udited in the manner required
At Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
strong roots • new growth
Date
Description
Amount
ENVH Revision Fee
$ 25.00
17-5-42462R- Raynor MCLamb Rd
Total Amount Due
Reason for check request: Homeowner changed his mind about doing the shop on the revision. See attached email.
This check request has been examined by me and is hereby approved for payment.
Head or Authorized Designee
. R.E.H.S.
This instrument has been
udited in the manner required
At Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
strong roots • new growth
Date