General Code
Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
ClAIMANT"S
NAMEAND
ADDRESS
General Code
781 Elmgrove Rd
Rochester, New York 14624-2991
Due on Receipt
TERMS
Purchase
Order No.
c:::2/
DO NOT WRITE IN THIS BOX
Date Voucher Received
FUND - APPROPRIATION AMOUNT
1410.404A
TOTAL $0 00
ABSTRACT NO. I
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
04-16-12 1 1.00 Balance Due on Invoice BILL007236 dated 02/29/12 $10 00 $10 00
TOTAL $10.00
Christine Fulton 1000
I. certify thai the above IICCOlI'lt In the emount of $ .
Is true and corract; that tha ttems, services, and dlsbursemants charged wera randerad to or for the munlclpallty on the dates stated; that no pan has been paid or satisfiad; that taxes. from which the
:::-~"-"""--~7~ TownC3erk
DATE SIGNATURE TITLE
(SPAeE-BEleWF0R-MUNleIPAl-tJSEj
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
< =0 ~ << <<'" ~ ,,~~ '" ~~
rODE:
.
GENE RAL 781 Elmgrove Road
Rochester, New York 14624-2991
(800)836-8834 * Fax(585)328-8189
Tax ill 20-8015087
r
Infrmnation made civil.
Invoice No:
Invoice Date:
Due Date:
Terms:
BILL007236A
4/16/2012
5/16/2012
Net 30
POi:
~oWJ2 of Wappinger
Christine Fal.ton
C/O C~erk's Office
20 Middlebush Road
Wappingers Fa~~s Nr
Customer No: WA0691
12590
Qty
1
1
Description
Original Invoice Amount - Supplement No. 23
Payment Received 3/30/12 Check #14193
Amoun t
$3,292.20
-$3,282.20
Balance Due on Invoice BILL007236 dated 2/29/12
Subtotal
S&H Charges
Tax EXEMPT
Pmt Rec'd
Total Due
$10.00
$0.00
$0.00
$0.00
$10.00
Interest will be charged on all past due
accounts at 1.5% monthly.
Thankyou 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 isa reasonable one. m . - U -- m . .-. . .. -
.. ~-_.~~.'-~-_.....__.__.._------~----~---~---~._._-~._-----------~_._----~_._~--_._--
Accounting Administrator
4/16/2012
Account Charged
Payment Record: Check #
Dated
Deptartment Approval
Date