General Code (3)
Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department: Town Clerk
Purchase
Order No.
40
CLAIMANT"S
NAMEAND
ADDRESS
General Code
72 Hinchey Road
Rochester, New York 14624-2991
Date Voucher Received
FUND - APPROPRIATION AMOUNT
It./JO.L/!J~
,
TOTAL $0 00
ABSTRACT NO. I
DO NOT WRITE IN THIS BOX
Due on Receipt
TERMS
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
05/12/2011 1 Additional Copy of Supplement 21 $29 82 $29 82
1 S&H $15 00 $15 00
$0 00
TOTAL $44.82
John C. Masterson 44 82
\, certify thet the above account in the amount of $ ,
is true and correct; that the items. services, and disbursements charged were rendered to or for the municipality on the dates stated; thet no part has been paid or satisfied; that taxes. from which the
municipality is exempted, are not included: and that the amount claimed is ually due
DATE
Town Clerk
05/12/2011
TITLE
(SPACE BELOW FOR MUNICIPAL 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
COMPTROLLER
DATE
AUTHORIZED OFFICIAL
DATE
GENERAL
[1:1) IJ ~
Page:
72 Hinchey Road
Rochester, New York 14624-2991
(800)836-8834 * Fax(585)328-8189
Tax In 20-8015087
1
Invoice No:
Invoice Date:
Due Date:
Terms:
GC0001577
5/6/2011
6/5/2011
Net 30
Customer No: WA0691
PO#:
Town of Wappinger
Mr. Cb.ris Masterson
C/O Clerk's Office
20 Middlebusb. Road
Wappingers Falls NY
12590
Qty
1
Description
Additional Copy of Supplement 21
Amount
$29.82
Interest will be charged on all past due
accounts at 1.5% monthly.
Subtotal
S&H Charges
Tax EXEMPT
Pmt Rec'd
Total Due
$29.82
$15.00
$0.00
$0.00
$44.82
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Voucher Form (if reauired)
Claimant's Certification
I do solemnly declare and certify under penalties of the law that the within
bill is correct in all its particulars; that the articles have been furnished
or services rendered as stated therin; that no bonus has been given or received
by any persons within knowledge of this claimant in connection with the above
claim; that the amount therein stated is justly due and owing; and that the
amount charged is a reasonable one.
~~.
Accounting Administrator
5/6/2011
Account Charged
Payment Record: Check #
Dated
Deptartment Approval
Date