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Smith, Constance
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TOWN O'Wa"IN..., NY
P,O. Box 324, MlddlebuthAold
Wappinger. Falll. N.Y. 12590
, PurGhIIe
~No,
bONOr,WltITeIN THIS 8,OX
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CLAIMANT'S .~
NAME AND 1:363 A-T .
ADDRESS . I I.-
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PURCHASE ORDER & vOUCHeR
TERMS
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REF,NO.
OATES
QUANTITY
UNIT PRICE
AMOUNT
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TotAl
1'6.00
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it lruulld ClllINCl: lhIIl\he "-, ...... IIld di~""'llI~.... .......I!t~ flit Il!it ~1llli.J~r......... ~ "* 110 _l\IiI~ lMIiCIor ........: Ihet lallet. Iram wIllc:h \he
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I DATi:
(SPACE"OW FOR~ USE)
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DEPARTMENT' APPROVAL
The above servl~.orm......s werere,ndereQC)I'
furnished to 'trnt mynlQ{paflty on thed8tes stated andt~
charges are correct '
APPROVAL FOR PAYMENT
, 'thia ct.im ia llIlI)fOVed paid fftlI'ft \tie ....,... lncllclltlld ebove
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OATE
1,' DATE
COMPTROLLER
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