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PAGE 1 OF i <br /> VENDOR4AME , VENDOR <br /> Dennis Coogan CODE <br /> VENDOR ADDRESS <br /> 837 Ocean Rd <br /> PAYMENT VOUCHER <br /> Madison WI 53713 <br /> DANE COUNTY, WISCONSIN <br /> ATTENTION VENDOR: The Following Is Required For Payment. <br /> 1) AUTHORIZED SIGNATURE & ITEMIZATION ON THIS VOUCHER. QR 2) AN ITEMIZED INVOICE. <br /> I VENDOR QUANITITY DESCRIPTION OF ARTICLE,MATERIALS,OR SERVICES UNIT <br /> INVOICE NO. PRICE TOTAL <br /> Refund of Rezone Petition Amount $100.00 <br /> For Petition #6868 <br /> Deposit in General Receipt #20630 on Jan. 31,1997 <br /> CERTIFIED BY (SIGNATURE) <br /> I hereby certify that the above itemized claim for <br /> One Hundred Dollars($ 100.00 <br /> ) TITLE DATE <br /> is true and correct and no portion of the same has been paid. <br /> Lin: COUNTY INVOICE NO. Sub Sub Revenue Sub Reporting BS I p <br /> Fund Agency Organiution Activity O . JOB NUMBER AMOUNT ig 01 Na (ACCOUNTING ONLY) Org Ol>j Source Rev. Category Account 0 <br /> F <br /> :>:.;:': 111 538 6=315 , .. 2100 �.. <br /> $100.00 <br /> ;DES¢AIp31Oa efu . rents ;e;petition amount,. petition wittidrawii per.:S Reynolds <br /> OESCRIPTI :iii :,;:;::. <br /> :: <br /> 08 . .. :::. <br /> 10 ;: ;;.;. <br /> TOTAL $100.00 <br /> THE ABOVE IS HEREBY APPROVED FOR PAYMENT } ' <br /> COMMITTEE (IF REQUIRED) FINANCE COMMITTEE / 'AGENCY (IF REQUIRED) <br /> f _ <br /> 014-64-05(7/B9) <br />