Wa Invoice Voucher Template
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1AGENCY USE ONLY
FORM
STATE OF WASHINGTON
AGENCY NO.
LOCATION CODE
P.R. OR AUTH. NO.
A19-1A
INVOICE VOUCHER
(Rev . 3/95)
227
001
AGENCY NAME
INSTRUCTIONS TO VENDOR OR CLAIMANT: Submit this form to
claim payment for materials, merchandise or services. Show complete
Washington State Criminal Justice Training Commission
detail for each item
Regional Training/Lee Brandt
st
19010 1
Avenue S.
Seattle, WA 98148
VENDOR OR CLAIMANT(
Warrant is to be payable to)
Vendor's Certificate. I hereby certify under penalty of perjury that the
items and totals listed herein are proper charges for materials,
merchandise or services furnished to the State of Washington, and
that all goods furnished and/or services rendered have been provided
without discrimination because of age, sex, marital status, race, creed,
color, national origin, handicap, religion, or Vietnam era or disabled
veterans status.
I also certify that I am receiving no other
compensation within the listed time frame.
BY______________________________________________________
|
(SIGN IN INK)
________________|________________________________________
(TITLE)
(DATE)
FEDERAL I.D. #. OR SOCIAL SECURITY #
RECEIVED BY
DATE RECEIVED
(For Reporting Personal Services Contract Payments to I.R.S.)
UNIT
FOR AGENCY
DATE
DESCRIPTION
QUANTITY
UNIT
AMOUNT
PRICE
USE
PREPARED BY
TELEPHONE NUMBER
DATE
AGENCY APPROVAL
DATE
DOC. DATE
PMT DUE DATE CURRENT DOC NO.
REF. DOC NO.
VENDOR NUMBER
VENDOR MESSAGE
USE
UBI NUMBER
TAX
REF
M
MASTER
INDEX
SUB
WORK CLASS
COUNT
CITY/TOW
ALLOC
TRANS
FUND
SUB
ORG
SUB
PROJ
DOC
O
SUB
Y
N
APPN
PROGRAM
PROJECT
AMOUNT
INVOICE NUMBER
CODE
OBJ
INDEX
PROJ
PHAS
SUF
D
OBJECT
BUDGET
INDEX
INDEX
MOS
UNIT
ACCOUNTING APPROVAL FOR PAYMENT
DATE
WARRANT TOTAL
WARRANT NUMBER
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