Costello, John F.
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TOWN 0' WA.........NY
P.O. Box 324, MlddlebulhR.-
Wapplngers Falls, N.V. 12580
.~
~No.
. 'W:'~"<.;L"',,-;''-
DO NOT WRITlIN THIS lOX
CLAIMANT'S
NAME AND
ADDRESS
r J I) r{ tJ F C? S 7 E Lc..O...,
VI 5 () I~ E t'1S E. fJA V~
UiJ ~ C' F PA Ld. S N~'f".I'<fS q ()
L ...J
.,
AMOUNT
PURCHASE ORDER aVOUCHIR
TOTAL
TERMS
~. .
"NO:. .
CE c.y 1
UNIT PRice
AMOUNT
OATES
QUANTITY
IJ-g- OS
'P'
TOTAL
.,~
/
~-,-
II'~ d '8"-oS
DATE
1('1 SPfcT"r,
TITLE
(SPACE.L~..~USI'
DEPARTMENT APPROVAL
The above services or materials were renderec:1 or
furnished to the municipality on. the detts Stated.ndthe
charges. are correct
A,Pf'.VALFOR PAVMENT
TIlia -'" 1a~_frol\'I \he~' indIceted pOvt
II/It /e!:"
. DATE
I
CATE
COMPTFtOLLEA
./1