Sabitus, Hedi
, ""'~""~'~:':/ "'.,' ~_~:'/-;;:~'f'~,'~1'~~!''i:T ""~~~~,'J:;i:'''~'~~'':?'''f?f;~~:~>-~ -';:"-,;. or"': ':'1""<(';~"'~.~",,~,:~..', ,-,~:\:_!" ~'l~.'"yP~- ~. ~_ '::'~<.'-'~-_'_~':";" _ "c::' _~____, ~,o;, -" ~ - ~ _~"'__ _. ........__ ';' :ff'_~':"-'-~~"""!'-)l'\1,....l,~~~
TOWN 0' WaIlPlMG..,MY
P.O. Box 324. Middlebuah Road
Wlpplngers FIliI. N.Y. 12590
. ;fl!urilhIa
, t 0rIf No.
00 NOT WRITE IN THIS BOX
PURCHASE ORDER & VOUCHER
0Ittll 'fclucIhIr.~. .
. tA110N
AMOUNT
r //$DI
CLAIMANT'S
NAMe AND
ADDRESS
,
S'Il 8 It"U~'
..,
(.
...J
TOTAL
I
L
TERMS
VENt.lQlIl'S
_NO.
OATES
QUANTITY
DESCRIPTION OF MATERIAL$OR$SJWtCes
UNIT PRICE
AMOUNT
136 00
,,(';
TOTAL
136~00
I. '. . . ... '. . . llIIlIf'j......~ IltII'IUI'''OUllI OfS
it ltUe and CllINct; ....Ihe 1Iema. MMoet. and ~ ctiii;ecI..\i'oM.......1O or for "'~Oll"'''~ ....IIO.......1lMn _ or utIalled: hi..... flam which the
I'IIUlIicipIIIl it ..emoted. - no! inc:luftd: and lhetlhe amount cIlIiI'II4l\IlealllvMy due
DATE
":'::t~.:~
I
..I.:'~lr~"p
SIGNATU..
.."') i\i'
:<
-
TITLE
(SPAcE 8iLOW FOR ~~ USE) .
.
.
DEPARTMEN'T,APPROVAL
The above servicesor'mlterials we... ...~rect.or
furnished to the municipality Qn the dlte. stated and the
charges are correct
APPROVAL FOR PAYMENT
This c1.im is .~ palct from II'Ie ~1ll'OPIia\iOn1 indk:atecl llbow
/~h~lec~
DATE
COMPTROLLEA