HomeMy WebLinkAboutab_vouch.pdf836 HANSHAW ROAD
(CLAIMANT - DO NOT VOUCHER #
DATE VOUCHER RECEIVED
ORDER NO.TERMS
VOUCHER
CLAIMANT'S
NAME AND
ADDRESS
Account Description Invoice # Amount
VILLAGE OF CAYUGA HEIGHTS
DEPARTMENT
ITHACA
PURCHASEDETAILED INVOICES MAY BE ATTACHED AND TOTAL ENTERED ON THIS VOUCHER.
CERTIFICATION BELOW MUST BE SIGNED.
WRITE IN THIS AREA)
Fund - Appropriation Amount
Total
ENTERED ON ABSTRACT NO.
G8130.410 280.01
649
008 01/17/2017
CHAREST COMPANY
PO BOX 626
BEMUS POINT NY 14712
280.01
G8130.410 50 LB Box Cotton T-shirt Rags 280.0116592
WWT PLANT - CONTRACTUAL
280.01
CLAIMANT'S CERTIFICATION
TOTAL
, 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 municipality on the dates stated; that no
Date
The above services or materials were rendered This claim is approved and ordered paid
or furnished to the municipality on the dates from the appropriations indicated above.
I,
part has been paid or satisfied; that taxes, from which the municipality is exempt, are not included; and that the amount claimed is actually due.
Signature Title
DEPARTMENT APPROVAL APPROVAL FOR PAYMENT
stated and the charges are correct.
Authorized Official Auditing Board
Date
(Space below for municipal use)
Auditing Board