07/2605 - Preliminary Building Works Assessable Against the Planning Scheme [As Published] · 172007.2605

NOOSA COUNCIL

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Supporting documentation must be attached for all payments

PAYMENT REQUEST FORM

Creditor No.

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

PAY TO:
(Max 40 Spaces) / (Aa tea Cre Sad tong
(2 lines only) 0p Bex ib Rye
NOOSA HEARS POSTCODE: §&Shx7
TYPE OF PAYMENT — Please tick appropriate box
GY REFUND QO)" REIMBURSEMENT (FBT form may be required)
Q] TRUST BOND RELEASE QO) ponation
QO) arants QQ Lasitity cLAim
(Q SUPERANNUATION PAYMENT (PAYROLL USE ONLY) QO) Lecats REQUEST
() CONFERENCE REGISTRATION (2 PERFORMANCE PAYMENTS
(3 EMPLOYEE DEDUCTIONS (PAYROLL USE ONLY) () OTHER (AS SPECIFIED)

 

 

 

® Details ~ Please tick the appropriate box if applicable (See procedures for more Information

 

CJ ASN holder. if yes, ABN #:
Qs Registered for Gst

FBT DETAILS — Please indicate If applicable

 

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

DESCRIPTION OF PAYMENT TO APPEAR ON CUSTOMER REMITTANCE — Maximum 40 characters
ez Ele lU|nip ole! o|vielalr alulad eia]- 21y Alela Kole J «alls

 

 

 

 

OICE/DOCUMENT REF

Alejo | 7 l2{élols| |

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ledger Number GL Narrative
General Ledger No. Sub A/c or Activity GST Amount (Description., Receipt No., Property No. etc)
Or Work order Task
(V2}ofolof* [é[z[27 [+ [rile al} Izv7sS SSYCAVY — Pofisfor
LITT Pettitt) Kepend cop re pe rgee al
Total Payment IVs

 

 

procedures.

 

SIGNATURE OF REQUESTING OFFICER
OATE; ft

 

| certity that the articles and/or services charged in the attached and/or detailed above were
satistactorily performed and according to an agreement with the above named AND that they were.
necessarily required for council AND that the charges wore fair and reasonable OR that appropriate:
suthorisation for this payment has been received by me in accordance with council's established

| cartity that this payment is being mada in accordance with the established payment
Procedures of the council and in accordance with the requirements of the Local Government
Act and that such payment is in accordance with the adopted budget of council end that the:
authorisation of this payment Is In accordance with my delegated authority fmit.

 

SIGNATURE OF AUTHORISED OFFICER o/

pare: Zt (&-) OF

 

PRINT NAME OF REQUESTING OFFICER

PRINT NAME OF AUTHORISED OFFICER:

 

Instruction to AP Team

 

 

Hold Cheque for: ___-—~
Post Cheque :(Y¥ed/ No

 

 

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