General Code (3)
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Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
CLAIMANT'S
NAMEAND
ADDRESS
General Code
72 Hinchey Road
Rochester, NY 14624-2991
Due on Receipt
TERMS
Purchase
Order No.
DO NOT WRITE IN THIS BOX
Date Voucher Received
FUND - APPROPRIATION AMOUNT
TOTAL $0 00
ABSTRACT NO. I
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
12/19/2008 1.00 Laserfiche Change Order for Additional Product $6,287 00 $6,287 00
Invoice # G0117044 $0 00
TOTAL $6,287.00
John C. Masterson 6 287 00
I, 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 included and that the amount claim(~~ Elctually due 1 t ~---- '
01/09/2009 "JQ-t:. '1/IV~ Town Clerk
DATE I6IGNATURE
; I
V
(SPACE BELOW FOR MUNICIPAL USE)
TITLE
DEPARTMENT APPROVAL
The above services or materials were rendered or
furnished to the municipality on the dates stated and the
charges are correct
DATE
AUTHORIZED OFFICIAL
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
COMPTROLLER
"
G'ENERAL
[K.) IJ ~
I
Page:
Sales/Edit:
Customer No:
72 Hinchey Road
Rochester, New York 14624-2991
(800)836-8834 * Fax(585)328-8189
Tax In 20-8015087
1
BC
WA0691
Invoice No:
Invoice Date:
Due Date:
Terms:
GOl17044
12/19/2008
1/18/2009
Net 30
Your Order:
SHIP TO:
Town of Wappinger
Mr, Chris Masterson
C/O Clerk's Office
20 Middlebush Road
Wappingers Falls NY
12590
BILL TO:
Town of Wappinger
Mr. Chris Masterson
C/O Clerk's Office
20 Middlebush Road
Wappingers Falls NY
12590
Qty
Description
Laserfiche Change Order for Additional Product:
50% invoiced upon completion
Amount
$6,287.00
Interest will be charged on all past due
accounts at 1.5% monthly.
Subtotal
S&H Charges
Tax EXEMPT
Pmt Rec'd
Total Due
$6,287.00
$0.00
$0.00
$0.00
$6,287.00
Thank you for choosing General Code. We appreciate your business.
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Voucher Form (if reauired)
Claimant's Certification
I do solemnly declare and certify under penalties of the law that the within
bill is correct in all its particulars; that the articles have been furnished
or services rendered as stated therin; that no bonus has been given or received
by any persons within knowledge of this claimant in connection with the above
claim; that the amount therein stated is justly due and owing; and that the
amount charged is a reasonable one.
V~~
Accounting Administrator
12/19/2008
Account Charged
Payment Record: Check #
Dated
Department Approval
Date