Voucher Template Town Of Highlands
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1TOWN OF HIGHLANDS
254 Main Street
Invoice No.
Highland Falls, NY 10928
Invoice Date.
Claimant's Name:
Terms.
Street:
Department:
City, State, Zip:
____________________________
Date
Quantity
Material or Services
Unit Price
Amount
Claimant's Certification
I,___________________________do hereby certify that all of the items of the above claim are true and correct; that the property or merchandise
show thereon was actually delivered; that the services show thereon were actually rendered; that the disbursements show thereon were actually
and necessarily made; that no part of such claim has been paid or satisfied.
I do further certify that I have been duly authorized and empowered by the claimant to execute in his behalf this certificate.
Dated:__________________
_______________________________________________
_________________________________________
(Signature)
(Title)
Departmental Approval
Audit and Approval for Payment
The Above Material or Services were Furnished
This Claim is approved and ordered paid from
or rendered to this municipality and the charges
appropriations indicated hereon.
Code No.
are correct
_____________________________
Check No.
___________
________________________
_____________________________
____________________________
(Date)
(Authorized Official)
_____________________________________
Voucher No.
_______________________________
____________________________
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