Grotzer, Hannah
,
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TOWN 0' wa........, NY
P,O. Box 324. Mlddlebuah Road
Wappingera Falla, N.V. 12590
:nON.
AMOUNT
DO NOT WRIT! IN THIS lOX
PURCHASE ORDER 1& VOUCHER
r 1I1IU,4J11 H GRoT 1:...E Ii..
CI..AIMANT'S ~ ~. DC; (;11 R 1J1() IJ IU S R b
NAME AND
ADDRESS UJ 19 P P I tJ <tIE. r;z s ~J9 L.4 S
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TOTAL
TERMS
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.NO.
OATes
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QUANTITY DESCRQlJTION OF NATlRW.8QR~'
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UNIT PRICE
AMOUNT
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TOTAL
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it lnIe lII'ld correcl: lhetlhe ltemll.llIl'YlceI, IIlCI ~ c:IIWI" .... ......lootfOr.. _I..~'....... ~ ... no JIII'\ _lIMn '*" 01....... lhet ..... 110m whlch ..
municlpIllly 1I....-npWd, _ not indudecI: lII'ld lhet .. ~ CIItIilMlI ialClUlllv:M '
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TITLE
DEPARTMENT APPROVAL
The above services or m.... were'rendered. or .
furnished to the municipality on thed8tes atated end..tt:\8
charges are correct .
APPROVAL FOfit PAYMENT
ThiS Cleim i. ~ llIld'fromttle ~ lndIcIIted <<loft
/~I/L Its
DAT~ ".
f\
DATE
COMPTftOLLER