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• <br /> ` PAGE OF <br /> VENDOR NAME • VENDOR <br /> David Dvorak CODE <br /> VENDOR.ADDRESS <br /> 216 Knoll Gt PAYMENT VOUCHER <br /> Deerfield WI 53531 DANE COUNTY, WISCONSIN <br /> ATTENTION VENDOR: The Following Is Required For Payment. <br /> 1) AUTHORIZED SIGNATURE & ITEMIZATION ON THIS VOUCHER. CSR, 2) AN ITEMIZED INVOICE. <br /> VENDOR OUANITITY DESCRIPTION OF ARTICLE,MATERIALS,OR SERVICES UNIT TOTAL <br /> I INVOICE NO. PRICE <br /> ■ <br /> Refund of Rezone Petition Amount $100.00 <br /> For Petition #6858 <br /> Deposit in General Receipt #20488 on Jan 22, 1997 <br /> CERTIFIED BY (SIGNATURE) <br /> I hereby certify that the above itemized claim for <br /> Dollars($ ) TITLE DATE <br /> is true and correct and no portion of the same has been paid. <br /> COUNTY INVOICE NO. Sub Sub Revenue Sub- Reporting BS I I <br /> Line JOB NUMBER AMOUNT <br /> Fund Agency Organization Or Activity Obi. obi, Source Rev. Category Account <br /> Na (ACCOUNTING ONLY) g 0 F <br /> 1.11 5:31k.,. 63 5 :: 21 0 . $100.00 <br /> 1:[1:..8:::-,FEE-Miada.W.M.U.O.M.,:..0g:::: ,..,..,.:... ::: ::<. :,-.,,,-........,......„......,,...,,,,......,............ , ., ....... ..................,....,.....,.......,.............:„....... . ,.........:..... ...... ...... . :,,, <br /> PESCRIPTIOl1 <br /> ;1?ESCRN?TIOliai ::: :.:.: : :: <br /> 04;:':>[>:::::.s:,.::..::>: :.::::.»:: ...::> ` ..»::: ?. ... .. <br /> 07 <br /> 08 .... <br /> 10 :<.•'>:.::::>. :>::> >.,>:'>:. <br /> ........................................ <br /> TOTAL $100.00 <br /> THE ABOVE IS HEREBY APPROVED FOR PAYMENT <br /> 'COMMITTEE (IF REQUIRED) <br /> FINANCE COMMITTEE AGENCY (IF REQUIRED) <br /> 014-64-05(7/89) <br />