HomeMy WebLinkAboutCheck Request for SNIA RefundCOUNTY 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
1103500-350410
Dennis & Sheri Medlin
999999
802 Holland Road
Fuquay-Varina, NC 27526
Description
Application was not heard
SNIA1908-0001
Please refund the amount above. Applicant withdrew application
X
Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: ______ Disapproved: _______
Amount
4500
4500
Date