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t -9 <br />Date Requested: <br />Vendor Number <br />Make P:lyable To: <br />Mailing Address: <br />Check Request <br />3/7/23 <br />261 <br />Florkla Municipal lttsur< Lice Trust. <br />P.0, Box 1757 <br />Tallahassee, rL 32302-1757 <br />Total Amount of Check Bequest: <br />Date Required: <br />General Ledger Account Code(s) <br />(1s:warop1e:001-0999-99 99-00) <br />0010000-155.00-00 <br />1.13-0210-515.45-02 <br />$ 17 1,394.25 <br />{) 3 /0 712 O 2 3 <br />Project# <br />Q PO l <br />001-0411-572,45-00 Q NO2 <br />Reason: FY23 Insurance Premium, `third installment <br />Requested By: _l ttn eta <br />FinatIce,Use Only -� <br />Invoice# <br />Description <br />'Special Handling <br />Please include a copy of the <br />invoice With check <br />Amount <br />a, iii Inc rn <br />122.50 <br />$ 75.25 <br />Depn ' nt I)t Director Signature Date <br />LAfA- <br />Finance SiO nature Date <br />01W CAzec:lc 1C(ILICS1 (W11- Expvnse Report <br />Rev 09/04/2018 <br />999910 <br />L,odging'llotel <br />11999955 <br />Police Dcpartrnom <br />99q9920 <br />State of Florida <br />9999960 <br />Lnlployee Reitubursements <br />9925 <br />Admin tFinance <br />9999965 <br />Non -Departmental <br />930 <br />Community Dev/('ode Comp <br />9999970 <br />Seminole County <br />(� <br />935 <br />Human Resources <br />9999990 <br />Refund -Water <br />t ..... <br />995 <br />Public Works/ParksrRec <br />9999995 <br />Utility Department <br />I'M <br />c stapiu <br />required original supporting dowme mtion. <br />Documullmlion that is smaller than <br />8'/1' x I I" must be taped to a blank paper of that size. <br />f5p <br />uilil..l landlittrt;_Notc any special instnictions itt tltis.area. <br />!lily documents thin must be remitted with the check must be paper clipped to this lurm <br />Rev 09/04/2018 <br />