General Code (4)
Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
CLAIMANT"S
NAMEAND
ADDRESS
General Code
72 Hinchey Road
Rochester, New York 14624-2991
Due on Receipt
TERMS
Purchase -') ~
Order No. ~ J
DO NOT WRITE IN THIS BOX
Date Voucher Received
FUND - APPROPRIATION AMOUNT
IL-I/()' "'"luLl
TOTAL $0 00
ABSTRACT NO. J
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
04/07/2011 1.00 Additional Copy of Supplement #21 $26 82 $26 82
1 Shipping & Handling $8 00 $8 00
.
TOTAL $34.82
l. John C. Masterson certify that the above account in the amountof$ 34.82
is true and correct; thai the items, services, and disbursements charged were rendered to or for the municipality on the dates stated; that no part has been paid or satisfied; that taxes, from which the
municipality is exempted, are not included: and that the amount claimed is actually due
9Jj"~
SIGNATURE
(SPACE BELOW FOR MUNICIPAL USE)
04/07/2011
DATE
Town Clerk
TITLE
DEPARTMENT APPROVAL
The above services or materials were rendered or
furnished to the municipality on the dates stated and the
charges are correct
DATE
AUTHORIZED OFFICIAL
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
COMPTROLLER
GENERAL
(<<.) 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:
GC0001510
4/1/2011
5/1/2011
Net 30
Customer No: WA0691
PO#:
Town of Wappinger
Mr. Chris Masterson
C/O Clerk's Office
20 Middlebush Road
Wappingers Falls NY
12590
Qty Description
1 Additional Copy of Supplement #21
Amount
$26.82
Interest will be charged on all past due
accounts at 1.5% monthly.
Subtotal
S&H Charges
Tax EXEMPT
Pmt Rec'd
Total Due
$26.82
$8.00
$0.00
$0.00
$34.82
Thank you for choosing General Code. We appreciate your business.
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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
4/1/2011
Account Charged
Payment Record: Check #
Dated
Deptartment Approval
Date