HomeMy WebLinkAboutS_Check_Request_Wetland_MM_LUA15-000026_20240105AP 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)
BILLING INVOICE EG00141384
1055 South Grady Way, Renton, WA 98057
Transaction Date: January 05, 2024
AR:
Eden Invoice:
DEPARTMENT: System Administrator
BILLING CONTACT
Natalie Needham
Harbour Homes LLC
400 N 34th St, 300
Seattle, WA 98103
REFERENCE NUMBER PAYMENT
METHODFEE NAME TRANSACTION
TYPE AMOUNT PAID
CH 57677 Refund Finance APPlan LUA15-000026 Wetland - Install, Maintain & Monitor
- Cash
Bond Release
$24,814.81 3954 (650.000000.000.237.00.00.000)
$24,814.81
SUB TOTAL $24,814.81
$24,814.81 TOTAL
Page 1 of 1Printed On: January 05, 2024 Prepared By: Stacy Tucker