Town Clerk PettyTown of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
CLAIMANT'S
NAMEAND
ADDRESS
Due on Receipt ~ ~ "~
TERMS
DO NOT WRITE 1N THIS BOX
r ~ ~..~-
65.00
I C11r1Stlne FUItOn certify that the above account in the amount of S
is true and correct; that 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
Town Clerk
10/24/2012 TITLE
DATE SIGNATURE
(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
~~~ ~/a-
DATE AUTHO ED FICIAL
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE COMPTROLLER
VENDOR'S ~ IC ~ ' ~ ~'
REFNO.
Purchase ~~ ~~~~ ~~
Order No.