07/0604 - Operational Works - Landscaping, Earthworks, Access & Frontage [As Published] · 142007.604

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 Boo NOOSA COUNCIL
noe PAYMENT REQUEST FORM Creditor No.
Supporting documentation must be attached for all payments
If a requisition for purchase order has been done DO NOT USE THIS FORM.
PAY TO:
(Max 40 Spaces) | YVastoe Cornrsnttive Affe
ADDRESS: P J
(2 lines only) ic & me [LoS
tT
MOOS 4 POSTCODE: (p+75/
TYPE OF PAYMENT — Please tick appropriate box
GY REFUND QO) __ REIMBURSEMENT (FBT form may be required)
Q) TRUST BOND RELEASE OQ _ponation
OQ crants Oswestry clam
OQ) _ SUPERANNUATION PAYMENT (PAYROLL USE ONLY) OQ) Lecats REQUEST
1 CONFERENCE REGISTRATION , O) PERFORMANCE PAYMENTS
QO) EMPLOYEE DEDUCTIONS (PAYROLL USE ONLY) O) OTHER (AS SPECIFIED)

 

 

 

GST Details — Please tick the appropriate box if a
ABN holder. ifyes, ABN #:

Os Registered for Gst

EBT DETAILS — Please indicate if applicable
Q

licabie (See procedures for more information’

Fringe Benefits Tax Declaration is required and is attached with a photocopy of receipt

DESCRIPTION OF PAYMENT TO APPEAR ON CUSTOMER REMITTANCE — Maximum 40 characte!
Relea! Lele elelab Melt [ole] EEL sl i2lel Ip fake L ek lel

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INVOICE/DOCUMENT REF (oh [A7eke ly] | TT
Ledger Number GL Namative
GST Amount (Description., Receipt No., Property No. etc)
$
clele “I7le a iyo Race ODF)
Total Payment t YO

 

 

 

| certify that the artkles and/or services charged in the attached and/or detailed above wera
satisfactorily performed and according to an agreement with the above named AND that they
were necassarity required for counci! AND that the charges were fair and reasonable OR that
appropriate authorisation for this payment has been received by me in accordance with council's
established procedures.

SIGNATURE OF REQUESTING OFFICER

DATE: _/ L

 

 

T certify that this payment is being made in accordance with the established payment
procedures of the council and In accordance with the requirements af the Local Government
Act and that such payment is in accordance with the adopted budget of council and that the
authorisation of this payment is In accordance with my delegated authority Iimit.

SIGNATURE OF AUTHORISED OFFERS

pare: Ut dé 1)

 

PRINT NAME OF REQUESTING OFFICER

PRINT NAME OF AUTHORISED OFFICER

 

Instruction to AP Team

 

 

{Ss Aw eoensyy

Hold Cheque for:

Post Cheque: Yes/ No

 

(Please refer to Accounts Payable Procedures doc. to ensure correct use of form)