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HALL COUNfY CLAIM FORM <br /> DATE 9/5/13 <br /> DATE DESCRIPI`fON AMOUNT CLAIM NO. <br /> LINE ITEM# 666-02-1801 70.00 <br /> 9-4-13 �outhRiskBehaviorsConferettce $70.00 LINE�rEM# <br /> n 9-16-13 <br /> 11rvE ITEna# <br /> ($35 x 2 : registration for Director& FAYABLE TO <br /> Diversion Officer) c[n�e rTenrt# <br /> L�NL t�re�t# DEPARTMENT OF HEALTH&HUMAN S£RVIGES <br /> �we rremt# 301 CENT£NNIAL MALL SOUTH PO BOX 95026 <br /> uNC tren-t# LINCOLN NE 68509 <br /> LINE ITEM# <br /> t� . <br /> , LINE I'I'EM# ���f���°��'Af `.��'� ������1��N r�; J. ��f::. . <br /> LIN£I'I'EM# � � ;s,� �^�� <br /> LINE ITFM# � . . . . . . . .. . . .... . .. <br /> LINE ITFM# AMOUNT $70.00 <br /> LINE ITEM# TOTAL 70.00 <br /> ACAINST HALL COUNTY <br /> JUVENIL£DIVERSION <br /> FOR wnference registration- <br /> TOTAL $70.00 JUVBNILE DEPARTMENT <br /> AFFROVED BY <br /> 1 do solemnly swear thaf the atqve account isjust end t�ve and that <br /> neither the same nor any pan the�eof has 6een paid. <br /> ` <br /> FAYABLE TO: EI.F.CI'ED or AP£OI £FICIAIS SIGNATURE <br /> ELEC['ED or APPO[N7'ED OFFICINS SIGNATURE Aud�ted an a owe by e County vnt the Cler <br /> ordered to issue a wamant in payment of this claim on the <br /> gy; GENERAL F[JND <br /> PLEA�E STAPLE ALL INVOICES ON THE BACK� ��a on warrant tvo. <br /> �t FACE SIDE UP. <br />