07/2399 - MCU - Lot Reconfig & Detached Houses (27) [As Published] · 132007.2399

BC RIE Noosa COUNCIL
ea oo PAYMENT REQUEST FORM

Supporting documentation must be attached for all payments

Creditor No.

 

 

 

 

 

 

 

 

 

 

 

If a requisition for purchase order has been done DO NOT USE THIS FORM.

 

PAY TO:

 

(Max 40 Spaces) Sfrarce Dew eta pyren ote Pl

 

ADDRESS:
(2 lines only) P oO —_— di HY
Nees A_ltEeap$

 

POSTCODE: (25%]

 

 

 

 

 

 

 

 

 

F PAYMENT — Please tick appropriate box
Gi REFUND C) REIMBURSEMENT ( FBT form may be required)
Q) TRUST BOND RELEASE ‘ Q) ponation
(Grants Qs wasirry cam
(2 _ SUPERANNUATION PAYMENT (PAYROLL USE ONLY) (} Leaats REQUEST
(2 CONFERENCE REGISTRATION QO) PERFORMANCE PAYMENTS
() EMPLOYEE DEDUCTIONS (PAYROLL USE ONLY) QO) oTHER (AS SPECIFIED)

 

a. Details — Please tick the appropriate box if applicable (See

for more Information

 

{.] ABN holder. If yes, ABN #:
CJ Registered for Gst

FBT DETAILS ~ Please indicate if applicable

 

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

 

 

INVOICEOCUMENTREF § [3[Sle[Clelal | I iL |

 

 

Ledger Number GL Narrative

General Ledger No. Sub A/c or Activity GST Amount (Description., Receipt No., Property No. etc)

Or Work order Task $ :

/ ol* 31 |" 3 o less Le trnnwol ef. Orerpe Aj

 

 

I Vv

ha ‘ “3 Sebed

 

 

 

 

 

 

 

O CeECECoceecoo

 

 

Total Payment “rs

 

 

Tac Gal Te WEES GRU GONADS Ghaiged WTS GIRGGT GROW GHMIGT BONS ware
‘satisfactorily performed and according to an agraement with the above named AND that they were
nacessarily required for council AND that the charges were fair and reasonable OR that appropriate
‘authorisation for this paymant has been recalvad by me in accordance with council's established
procedures.

 

‘SSGNATURE OF REQUESTING OFFICER
DATE:

1 cortty that this payment is being made in mocordance with the established payment
procodures of tre councd snd in accordance with the requirements of tee Local Gover nent
Act and that such payment is in accordance with the adopted budget of council ard that the
‘authorisation of this payment Is In accordance with my detegated authority Frit.

PS Kren

SIGNATURE OF AUTHORISED OFFICER /

pare THC ST

 

| PRININAME OF REQUESTING OFFICER

FAINT NAME OF AUTHORISED OFFICER

 

Instruction to AP Team

 

 

_
Hold Cheque for: (Ri Sth

 

 

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