Laserfiche WebLink
SNOHOM I SH COUNTY 4-1-1— <br /> HUMAN SERVICES DEPARTMENT <br /> 3000 ROCKEFELLER,M/S 305 <br /> EVERETT,WA 98201 <br /> AGENCY CERTIFICATION FORM <br /> Agency Certification: I hereby certify under penalty of perj ury that the items and totals I i sted herein are proper <br /> charges for materials, merchandise, or services f urni shed to Snohomish County,and that all goods furnished and/or <br /> services rendered have been provided without di ri mi nation on the grounds of race, creed, national origin, handi Lad, <br /> sex,or age. <br /> AUTHORIZING SIGNATURE: DATE: <br /> Voucher Invoice Total Charged To: <br /> Check# Vendor Refer.# Description Amount Non-Grant Grant <br /> (Use Additional Pages as Necessary) Total: $ - $ - $ - <br /> Exhibit D <br /> BH-22-62-06-198 <br /> City of Everett <br /> Page 2 of 2 <br />