General CodeTown of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
General Code
CLAIMANT'S
NAMEAND 781 Elmgrove Road
ADDRESS Wappingers Falls, NY 12590
Purchase
Order No.
DO NOT lT IN THIS BOX
Date Voucher Received
FUND-APPROPRIATION AMOUNT
A1410. 1~ $4,334 89
TOTAL $4,334 89
ABSTRACT NO.
Due on Receipt VENDOR'S
TERMS REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
03/12/2013 1.00 Code Analysis $2,411 96 $2,411 96
1 Composition $1,442 92 $1,442 92
1 Duplication, Finish & Handling $441 98 $441 98
1 Shipping and Handling $38 03 $38 03
TOTAL $4,33 4.89
t Christine Fulton 4 334.89
certify that the above account in the amount of $
is true and correct; that the items, services, and disbursements charged were rendered to or for the munlGpallty on the dates stated; that no part has been paid or satisfied; that taxes, from which the
muniGpality is exempted, are not InGuded: and that the amount Geimed is actually due
03/13/2013 ~~ ~w41,~,~~ Town Clerk
DATE SIGNATURE 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
DATE
AUTHORIZED OFFICIAL
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
COMPTROLLER
G~ N E RA L 781 Elmgrove Road
"" ^e~ sac~^~is~~ ~~:~ Rochester, New York 14624-2991
(800)836-8834 ' Fax(585)328-8189
Tax I D 20-8015087
Information made civil.
Bill To:
Town of Wappinger
Christine Fulton
C/O Clerk's Office
20 Middlebush Road
Wappingers Falls, NY 12590
Supplement P~oject_
Supplement No. 25 Quantity 22
Invoice No. BILL010445
Date: 3/8/2013
Due Date: 4/7/2013
Terms: Net 30
Customer No. WA0691
~~~~~~:~~i~
MAR 1 1 2013
~'
PO No.
Item Billing Amount Tax Total
Code Analysis $2,411.96 $0.00 $2,411.96
Composition $1,442.92 $0.00 $1,442.92
Duplication, Finish & Handling $441.98 $0.00 $441.98
Shipping & Handling $38.03 $0.00 $38.03
$4,334.89 $0.00 $4,334.89
Interest will be charged~on all past due accounts of 1.5% monthly.
Payment applied:
Total Balance Due $4,334.ss
This order is subject to General Code's Terms and Conditions which are
available at www.generalcode.com/TCdocs
Voucher Form (if required)
Claimant's Certification
I do solemnly declare and certify under penalties of the law that the within
bill is correct in a!I its -particulars, that the articles -have been furnished
or services rendered as stated therein, 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: '~~
3/8/2013
Account Charged
Department Approval
Accounting Administrator
Payment Record Check# Hated
Date
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