Saba, Kim
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TOWN OF WAIIPINGIR, NY
P.O. Box 324, Mlddlebulh Road
Wappinger. Falll,N.Y. 12590
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DO NOT WRITE IN THIS BOX
CLAIMANT'S
NAME AND
ADDRESS
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''''~''~MlATION AMOUN T
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*tfW:T NO. I
PURCHASE ORDER & VOUCHER.
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TERMS
1IIlWOOR'S
QF.NQ.
OATES
QUANTITY
DeSCRIPTION OF MATIRlALSOR $ERvlCES
UNIT PRIce
AMOUNT
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136 00
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Cle.
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4 00
. TOTAL
140.00
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iI true IIld CllrNCl: Ihat \he M_. ..... IIld ~ chllI9Id'~."""'1O
~ iI ~. ... no! inc:Iuded: IIld \hellht IIfIW.lUftl CleimeCllallClllMillv'"
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DATE
..., 1lIII"~ lICCOUnlln .. -' _ s
~.. ~ "'...... ~ lIlaI no '*' ... been _ or tIlIIfted: lIlaIlII-. flom which \he
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SlGHAME
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TITLE
(SPAce ULOW FOA ~ USe)
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DEPARTMENT APPROVAL
The above services or meteritfs were.,.nqerect or
, furnished to themuniQipetityon the dates stated end the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved pekl fl'OIntle ~ indiCated aboft
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DA
DATE
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