Harrison, Ricky
.... -', '.' .. ....
!'5JY.,',"
:,::_\;c'\';('~ ','
iI!"
~,.
\
TOWN 0' WA........, NY
P.O. Box 324, MlddlebulhROld
Wapplngers FaNI, N.Y. 12590
~
OIdIfNO,
00 NOT WRIT! IN THIS lOX
r 'Nt ~" r llAj)A '^
I' ,,(, '.... H:. "'~. n nN"I$Yt l
CLAIMANT'S J r;f > (i ^ \ \ n '-t lJ a tV ~<tA~::. t
NAME AND v 'll ~ r A, \>
ADDRESS W.. t.', I> &\ ".r! 10. , u.. #..:1.'5 70
~r'}h" I "to. N""f .
-,
IilIdI \Iouclltr ~
FUNO .APP~TION AMOUNT
. .'. .
" ..'~
.
. ..
. I: TOTAL
i~CTNO. .'~".. '} I
PURCHASE ORDER It VOUCHER
L
...J
TEl(~S
veNDOR'S
RtF.IiIO.
DATES
QUANTITY
DESCRIPTION OF MATERIAL$Qjit~
UNIT PRICE
AMOUNT
l:Jpltr
Ih.k.
/Jh,IOS'
.
'I~ SUlVI(~
V6+1 ('Ij (i\,.J,.:fl'l! S
)~~/
TOTAL
1507) I
I. ;;t\ j .. ...t. .. CIltlti... ....MlcMlIOCIIIlIIlIn the _nt of S . /5 ()() I d"()
illrIIe end --': theI the "-. ...... .,~" ~.., ..... toor.for...1IlIInIcilpIlIt on till .. ~;thIl no pelt .. lIMn pelcl or utIded: thet III.... '"'"' wlllch the
~~:~-~h-1tJ'~2?/i>..... S2.1J'(~!M n~:~h~'\'
. ...~t ....l..OW~~'rw.U$E) "
;$
DEPARTUIN.T APP~C)"AL ,:," "\~...,
The a~<ie services or materials Wftfe","dered.or ~
fumishlct to the municipality on th~ dates.tate4,;~.:~
charges are correct . "l~
'"
jJND~
APPROVAL FOR PAYMENT
Thiacllim Is ~pald.fiom the eppropriallonl indICated abo~
,
~i--..;';;;
DATE
COMPTFtOLLE~
. ,.