ENVH Refund for WellHarnett
UN
NORTH CAROLINA
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date 6-16-11
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00
Michael Shrieves
205 Helen Lane
Dunn, NC 28334
(Requires approval of Finance Officer)
Approved: Disapproved:
Description
Amount
Environmental Health New Well
$ 250.00
Construction fee # 11-5-27171
Site: 205 Helen Lane, Dunn NC
Total Amount Due
$ 250.00
Reason for check request: Per James Manhart, applicant decided that he did not want a well.
This check request has been examined by me and is hereby approved for payment.
Department
Graham H. Byrd, R.E.H.S._
I
Mail to payee
Check to be picked up by:
Date
This instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director