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["FORM\nA-19-1A\n(Rev. 6/95)",null,"STATE OF WASHINGTON\nINVOICE VOUCHER",{"$nulls":4},"AGENCY USE ONLY"]
[{"$nulls":7},"AGENCY NO.","LOCATION CODE",null,"P.R. OR AUTH. NO."]
[]
[]
["AGENCY NAME"]
["\n",{"$nulls":6},"INSTRUCTIONS TO VENDOR OR CLAIMANT:  Submit this form to claim payment for materials or services.  Show complete detail for each item."]
[]
[]
[{"$nulls":7},"Vendor's Certificate.  I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital  status, race, creed, color, national origin, handicap, religion, or Vietnam era or disabled veterans status."]
[]
[]
[]
["VENDOR OR CLAIMANT  (Warrant is to be payable to)"]
[{"$nulls":7},"BY"]
[{"$nulls":7},"(SIGN IN BLUE INK)"]
[]
[]
[{"$nulls":7},"(TITLE)",null,null,"(DATE)"]
[]
[]
["FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For Reporting Personal Services Contract Payments to I.R.S.",{"$nulls":6},"RECEIVED BY",null,null,"DATE RECEIVED"]
[]
[]
["DATE","DESCRIPTION",{"$nulls":3},"QUANTITY","UNIT","UNIT PRICE","AMOUNT",null,"FOR AGENCY USE"]
{"$rows_empty":8}
["PREPARED BY",null,null,"TELEPHONE NUMBER",null,"DATE",null,"AGENCY APPROVAL",null,null,"DATE"]
[]
[]
["DOC. DATE","PMT DUE DATE","CURRENT DOC. NO.",null,"REF. DOC NO.","VENDOR NUMBER",null,"VENDOR MESSAGE",null,"USE TAX","UBI NUMBER"]
{"$rows_empty":15}
["ACCOUNTING APPROVAL FOR PAYMENT",{"$nulls":6},"DATE","WARRANT TOTAL",null,"WARRANT NUMBER"]

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