Barbara Barbour - 43488COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Total Amount Due
Reason for check request:
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee
This insturment has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
_____________________________________
Harnett County Finance Director
110-0000-322.30-01
4270
Barbara Barbour
350 Wagoner Dr
28 Barbour Ln
Fuquay Varina, NC 27526
Description
Customer did not need
permit
18-500044378
*****Please add note in red to refund check******
X
Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: ______ Disapproved: _______
Amount
60
60
Date