Dutchess County Dept of Health
- ..
TOWN OF WAPPINGER, NY
P.O. Box 324, Middlebush Road
Wappingers Falls, N.Y. 12590
F>urch..e
Order No,
DO NOT WRITE IN THIS BOX
r
I
DAte Voucher Received
FUND. APPROPRIATION AMOUNT
TOTAL
ABSTRACT NO, I
PURCHASE ORDER & VOUCHER
CLAIMANT'S
NAME AND
ADDRESS
Dutchess County Dept. of
387 Main Street
Poughkeepsie, NY 12601
L
Health
...J
TERMS
VENDOR'S
REF,NO
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
8/13/06 Animals Vaccinated: 66 @ $1.00/animal = $66.00
Syringes Wasted: 2 @ $.43/syring = $.86
Vaccine Wasted: 2 doses @ $.85/dose = $1.70 68 56
I
TOTAL 68 56
_.,
I. John C. Mas terson certify thet the above account in the amount of $ 68.56
is true end cornect; thaI the Items. ..rvlces. and dlsbursaments charged "'ere rendared to or for the munlcipalily on the dales stated; Ihat no part has been paid or sahsfied; that taxes. from which the
municipality i. exempted, are not included; and that the amount claimad is actually due
August 30, 2006
DATE
SIGNATURE
Town Clerk
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
OEPARTMENT 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 peid from the appropriations indicated above
DATE
AUTHORIZED OFFICIAL
DATE
COMPTROLLER
Dutchess
County
Department
of Health
William R. Steinhaus
County Executive
Michael C. Caldwell,
\1f}.MI'H
Commissioner
Environmental Health
387 Main Street
Poughkeepsie
New York
12601
(845 )486-3404
Fax (845)486-3545
August 28, 2006
Wappinger Town Hall
Attn: Chris Masterson, Town Clerk
20 Middlebush Road
Wappingers Falls, New York 12590
RECEIVED
AUG 3 0 2006
TOWN CLERK
Re: Rabies Clinic - August 13, 2006
Schlathaus Park, Town of Wappinger
Dear Mr. Masterson:
Based on my review of all items returned after the August 13 clinic, it was noted
that 66 pets were immunized and 68 doses of vaccine and 68 syringes were
utilized.
As such, please forward a check in the amount of Sixty-eight dollars and fifty-six
cents ($68.56) due and payable to the Dutchess County Department of Health for
the following:
Animals Vaccinated: 66 @ $1.00/animal = $66.00
Syringes Wasted: 2 @ $.43/syringe = $.86
Vaccine Wasted: 2 doses @ $.85/dose = $1.70
TOTAL:
$68.56
If you should have any questions, please feel free to contact me at (845) 486-
3404. Thank you.
YJ~;;~
Monique Jones
Public Health Education Coordinator
Environmental Health Services
File: Town of Wappinger bill.doc
Owner's Name & Address
PRINT - Last,
No. \<
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Dog U/
Cat 1]1'
Name
l Street
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Sex:
Male a
Female tj
RABIES VACCINATION CERTIFICATE
NASPHV Form #50
Print - use ball point pen or t e
,First.
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Rabies Tag Number
M.1. Telephone
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Age:
3 mo. to 12 mo>O
12 mo. or older a 20-50Ibs.
Over 50 Ibs.
Producer: CI:=r=J d 1 y,. Lic.Nacc.
(First 3 letters) 0 3 yr. Lic.Nacc.
For Licensing Agency Use DATE VACCINATED:
License No. Year ( \,'
Other
Change a Add 0
Control No.
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Other
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Veterinarian's: #
Month
Day
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Year
VACCINATION EXPIRES:
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Month
Day
Year
Vacc. Serial (lot) No.
License No.
Signature
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