HomeMy WebLinkAboutCHECK REQUEST-Elliot Refund BOA ApplicationCOUNTY OF HARNETT
CHECK REQUEST FORM
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Refund
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
110-0000-322-20-00
H T E # 17-475 P/Z
Fred Allen Elliott Jr.
720 Gentle Slope Way
Raleigh, NC 27603
Description
Conditional Use Application Fee
Customer pulled application
X
Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: ______ Disapproved: _______
Amount
175
175
Date