06/0159 - Op Works - landscaping, Driveway and Stormwater [As Published] · 142006.159

ae NOOSA COUNCIL
nen Ml PAYMENT REQUEST FORM:

Supporting dacumentation 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) NC Oliwev Pio eves
ADORESS: °
(2 lines only) Cl Vc ddap Di chGeld | dar Many + T Nomas Sis
Nossaville _G. ; PQST cove: 4c(,
TYPE.DF PAYMENT - Pi propria
REFUND ~ oe Q

1 _ TRUST BOND RELEASE ‘ Q

Q_crants OQ wasury’ cua

Q]__ SUPERANNUATION PAYMENT (PAYROLL USE ONLY) |) LeGats REQUEST

C) CONFERENCE REGISTRATION Q PERFORMANCE PAYMENTS

OQ _ EMPLOYEE DEDUCTIONS (PAYROLL USE ONLY) Q]_oTHer (as SPECIFIED) Asari

 

 

 

 

 
   
 

Oo ABN holder. ttyes, RON
C) Registered for Gst’

T DETAILS = indi it I
CY Fringe Benefits Tax Oeciaration Is required and is attached with a photocopy of receipt

CRIPTI Ni F PAYM
6 v ara PIA Ime

 

 

 

  

 

Ledger Number TSU Na
GST Amount Ores ‘Receipt No, Property No. etc)
$

 

 

 

VACO eee eR HO ob IS

 

 

 

 

 

 

 

 

 

 

 

 

Total Payment x oO

 

 

 

| corm that the artcles andicr services chusged wn the attached and/or detaled above were | | certly inal itm payment ia Beng made im accordance with the esisbushed paynertt
sahetactonly performed snd according to an agreement with Te above ramed ANO that hey | procedures of the council and in eccontanca wih the requirements of tie Local Government
were Necessaniy Cequited for councd ANC that the charges were few and reasonanie OR that | Act and thal such payment is in accordance with ine adopted budge! of councd and that the

@ppropnuite authonsanon for Uke prymant has been received by mein eccortance with councy’s | suthorsaton of this payment «in accordance with my delegated autho: wt
‘esiaohaned procedures

SIGNATURE OF AUTHOR'SED OFFICER
SIGNATURE OF REQUESTING CFFICER

 

 

 

 

 

OaTE f OaTE. h i
“ERIN NAME OF REQUESTING OFFICER PRINT NAME OF AUTHORISED OF FIGER

 

Instruction to AP Team Hold Cheque for:

 

Post Cheque: Yes/ No

 

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