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r ACCOUNTS PAYABLE CHECK REQUEST
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Request Date 12/10/2021 Department Choose one or Type
Check Payable to POLYVISION LAND CORP.
J.
CITY OF 6430 LOMA AVE
RCADI Address
City,State,Zip Code TEMPLE CITY, CA 91780
INVOICE NUMBER(S)
(if applicable)
ACCOUNT NUMBER(S) AMOUNT
714-2275 $ 2,009.00
$
$
S
$
TOTAL CHECK AMOUNT $ 2,009.00
Reason for Payment:
DEMOLITION BOND PERMIT DEMO-21-0306
1519STENiHAVE
A APPROVED BY,.Y(MUSTT BE SIGNED BY,AUTHORIZED SIGNERS).' ".
Signature Date Approved
2nd SIGNATURE REQUIRED'EOR ANY CHECK AMOUNT AVER$2;500, ,$. .. s,:,
Signature Date Approved
ACCOUNTS,PAYABLE USE ONLY.. ..
Check here if check is to be ri Reviewer's Initials
returned to Department
VR112019