HomeMy WebLinkAboutCheck_Request_Wetland_MM_LUA00-156_20250515AP Check Request Form
City of Renton - Finance Department
1055 South Grady Way – 5th Floor
Renton, WA 98057
FinanceAP@rentonwa.gov
Instructions: Use this form for all payment requests including: employee reimbursements, customer refunds, or recording wire or EFT payments
__________________________________________________ ________________________________________
Requestor’s Name Ext. Requestor’s Department/Division
_____________ ___________________________________________________ _____________________
Vendor # Payable To Date
_______________________________________________________________________ _____________________
Check Description Total Check Amount
__________________________________________________________________________________________________
Address for Check City State Zip
Employee Reimbursement
Customer Refund
Wire/EFT Payments (If wire attach instructions)
Wire/EFT Date _______________________
Other ________________________________
Notes/Comments/Check handling instructions:
________________________________________________________
Emergency Check (outside normal check run)
Date Needed __________________________________
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
Signature Printed Name Date
Check Information
Type of Check Request
Account Numbers (GL format: xxx.xxxxxx.xxx.xxx.xx.xx.xxx)
Approver Authorization (Department Administrator, Director, or designee)
RECEIPT (EG00153488)
FOR CITY OF RENTON
BILLING CONTACT
Office at Southport, LLC
1133 Lake Washington Blvd N
90
Renton, WA 98056
Payment Date: 05/15/2025
Reference Number Payment MethodFee Name Transaction Type Amount Paid
Contacts Account Refund
Finance AP
Refund $30,000.00 ACCT# 000020-2016
SUB TOTAL $30,000.00
TOTAL $30,000.00
Page 1 of 1May 15, 2025 3:41 PM
REFUND RECEIPT