Invoice Invoice Name of Description of Item State County Total County Date Number Vendor Materials* Cost Tax Tax Invoice Name TOTALS: Enter totals from all pages into Certification Page. This page is used whether Certification Page is by the Contractor or the Subcontractor. Rev. 08/2011
Invoice Date Invoice Number Name of Vendor Description of Materials* Item Cost State Tax County Tax Total Invoice County Name TOTALS: Enter totals from all pages into Certification Page. This page is used whether Certification Page is by the Contractor or the Subcontractor. Rev. 08/2011