Atlas Star (4)
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TOWN OF WAPPINGER, NY
P.O. Box 324, Middlebush Road
Wappingers Falls. N.Y. 12590
Purchese
Order No.
DO NOT WRITE IN THIS BOX
r~ T1~ STt'\ (2..
CLAIMANT'S \ \ 5<'P ROt>li2 Cf Sv.k 12-
NAME AND h "-
ADDRESS ~ 4-m PwtJ gu~ f r-..iC.SS C. ~
L Lvil-{Jf/ ~(!.S f:1t1\~ N'I J dS10
....,
DlIte Voucher Received
FUND. APPROPRIATION AMOUNT
~
TOTAL
ABSTRACT NO. I
PURCHASE ORDER & VOUCHER
--I
TERMS
VENDOR'S
REF. NO.
DATES
QUANTITY
DESCRI~TION OF MATERIALS OR SERVICES
UNIT ~RICE
AMOUNT
I Af- -Y5o T()IJfZf-.
I h IfPl~ I~ /ttVflLl tJ6-
be.- Slt-l~.5 ~
(PI)
TOTAL
I, certify thet lIIe ebove eceount in the emount of S
is true end conecl: thet the IIems. services. end disbursements cherged ..... ..ndered to or lor the municipellty on the de"s ste'.d: thet no pert hes been peid or setislled: thet te.... from which the
municipeHly is ..empt.d. e.. not included: end thet the emount clei ectuelly due
4 J OJ::
7 cJl.c)y\ CL €1lK
TITLE
(S~ACE BELOW FOR MUNICI~AL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered. or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
AUTHORIZED OFFICIAL
DATE
COMPTROLLER