STATE OF WASHINGTON INVOICE VOUCHER WASHINGTON STATE UNIVERSITY 365 DEPART MANE | Community Revitalization / Horizons Program. INSTRUCTIONS TO VENDOR OR CLAIMANT: ‘Submit this form to clam payment for materals, merchandise or services [PURCHASE ORDER NO. OR TRAVEL AUTHORITY NO._] 8.26.08 Tels unlawl for any state age provided by law bocauss ni Eeccnny nbs except in spaced crcumstanas, WSU eau that on the Ina Reverue Code, When requed, secunly numbers for IRS repering purposes only. ‘ua OBE Show complete dota for each hm. PO Box 1495 Spokane WA 99210 1495, VENDOR'S CERTIFICATION Peet DEPART CANTAT [owacrTavONENO. ‘hereby cently under penalty of perjury that the toms ard totals sted Cindy McHargue 509-358-7548 fro oe proper chro format, merchandoo, or Sovies VENDOR OR CLAIMANT, pede ‘i deny any ight, benef, or pre vial uses to dladoge his or her socal navi Yoqueding payment rom WSU dele ssl ary nuit or empeyar hat (in) pursuant to Secon 6108 of me 3U will use disclosed social DATE DESCRIPTION [vant [UNIT] UNIT PRICE “AMOUNT, Print your name znd address in the claimant box above. ‘Sign your name in the claimant’s box above right. (First Child)___childx $S/hour x _ hours = (Plus)__# of other children x $2/hourx _ hours = OR ‘Maximum per family $30 for half day meeting, $60 for full day meoting (4+ hours) Elder care is $7 per hour Fill in the amount you are seeking for childcare based on: TOTAL DEPARTMENT: Please sign and enter the appropriate account code. ‘SENATU DATE ‘TYPEDIPRNTED NAME Cindy McHargue acco cone Bose a ‘AMOUNT ‘NON aK ~ 4108 TOTALS ———>-