Fulton
Print Form I
Village of Wappingers Falls
Purchase
Order No.
2628 South Ave
WAPPINGER FALLS, NY 12590
Telephone: (845) 297-8773 Fax (845) 298-2645
DO NOT WRITE IN THIS BOX
CLAIMANT'S
NAMEAND
ADDRESS
Christine Fulton
Date Voucher Received
FUND - APPROPRIATION AMOUNT
TOTAL $0 00
ABSTRACT NO. I
PURCHASE ORDER & VOUCHER
Department:
18 Park St
Wappingers Falls, NY 12590
Due on Receipt
TERMS
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
Reimbursement for Vital Statistics Fees
Death Certificates - _Copies
TOTAL
Christine Fulton certify that the above account in the amount of$ .
is true and correct; that the items, services, and disbursements charged were rendered to or for the municipality on the dates stated; that no part has been paid or satisfied; that taxes, from which the
municipality is exempted, are not inciuded: and that the amount claimed is actually due
DATE
SIGNATURE
Town Clerk/Registrar
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
AUTHORIZED OFFICIAL
COMPTROLLER
DATE
DATE