HomeMy WebLinkAboutCO2015-3575
City of Grapevine
CHECK REQUEST FORM
Date10/21/15
DepartmentDevelopment Services
Vendor No.
Vendor NameSerhan Ozbek
Street or P. O. Box1452 Sierra Springs Dr. Unit 924
City, State, ZipBedford, TX 76021
Invoice # and Invoice DateAccount NumberAmount
10/21/15100-32115-417-2$40.00
Total$40.00
Explanation/Refund 80% c/o application fee, not moving in
Special
Instructions
Authorized/Dept. Head Signature
Latest Date for ProcessingFinance Dept. Signature
Mail Do Not Mail/Will Pick UP ______ Do Not Mail/Return to Dept ______Mail/ Will Pick UP _____ Do Not Mail/Return to Dept. _____