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CLA TO NOF YSTERB Y IM DETAILED DESCRIPTI (Oyster Bay Town)

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CLAIMAN



CLAIMAN



TOWNDE



DATE



THEBELO

IHEREBY

Townof

correct;t

intheam

isactually

CLAIMAN

deliveries.

Signature

Printorty





IHEREBY

indicated

Signature



FORINTE

InvoiceDa



'SNAME

'SADDRESS

PARTMENT

FOLLOWINSTR



CERTIFICATI

ERTIFYtheabo

ysterBayonth

atnopartther

untof

dueandowing,

FURTHERCER



pename

  

PPROVEthiscl

hichwereact





NALUSEONL

te Vendor#



AUDREYAV

UCTIONSONR

NMUSTBEPR

earticleswere

datesandfor

ofhasbeenpai

andthattaxes

IFIESthattheu

____________



 

imformforth

allyperformed

:

Invo



NOF

CLA

ENUE,OYSTE

VENDOR



VERSESIDETH

DETAILED

PERLYFILLED

soldanddelive

hepricesoram

dexceptasstat

romwhichthe

itpricescharg

___________

sumof_____

andwereforth

ce#

YSTERB

IM

BAY,NEWY

# CONT



CONT



CLAI



NRETURNCL

DESCRIPTI

CRIPTION

UTBYTHECL

redand/orthe

ountsbilled;th

edthereinand

ownofOyster

dhereinaren

____ Title

____ Name





____________

eTownofOyst



Title 



Dept.

  

RK11771



ACT#

ACTNAME

ANTINVOICE#

IMANDINVOI

NOFMAT

IMANT

boveservicere

ttheabovebill

hatthebalanc

Bayisexempta

thigherthant

ofCompany

____________

rBay.

Fund F



ESTODEPART

RIALSORS

nderedtothe

isjust,truean

thereinstated

reexcludedthe

osechargedto

____________



___________f

unction

  

TAX

FED





INVOICED



ENTRECEIVIN

RVICES

UNIT



TOTALA



CASHDIS

NETAM



refrom.



anygovernmen

____________

 

rtheservices,

MainAcc.



PAYERIDENTIFI

RALID#

ER#

TE RE



GMATERIALS

RICE

OUNT

OUNT%

OUNT



talorcommerci

______ Dat

____________



isbursements



Date



SubAcc.

  

CATIONNUMB

OCIALSECURI

SO#

RSERVICES

TOTAL



alconsumerfo

 __________

___________



ndmaterialsh

Auth S



#

like

____

_____

rein

urce

 

$0.00

INSTRUCTIONS



TAXPAYERIDENTIFICATIONNUMBER‐Checktheappropriateboxtoindicateifthetaxpayeridentificationnumberis

eitheraFederalID#oraSocialSecurity#.ProvidetheClaimant'sTaxpayerIdentificationNumber(TIN)ontheline

provided.



CLAIMANT'SNAMEANDADDRESS‐Allclaimantsmustprintortypewritetheirnameandaddress

inthespaceprovided

forthepurpose.Thecheckwillbedrawninthatnameand mailedtothataddress.Claimant'sTaxpayerIdentification

Number(TIN)mustbefurnished.



VENDOR#‐Internaluseonly.EntertheTowns'sinternalvendornumber.



TOWNDEPARTMENT‐Indicatethedepartmentthatreceivedtheservicesorsupplies.



CONTRACT#ANDCONTRACTNAME‐Ifacontractnumberandcontractnamethathasbeenissuedfortheitems

chargedonthisvoucher,showthenumberandnamethereof.



ORDER#‐Ifapurchaseorder,serviceorderorencumbranceorderhasbeenissuedfortheitemschargedonthis

voucher,

showthenumberthereof.



CLAIMANTINVOICE#‐Entertheclaimant'sinvoicenumbercorrespondingtomaterialsfurnishedorservicesrendered.



INVOICEDATE‐Entertheinvoicedatefromtheclaimant'sinvoicecorrespondingtomaterialsfurnishedorservices

rendered.



RESO#‐Ifapplicable, entertheTownResolutionnumbercorrespondingtomaterialsfurnishedorservices

rendered.



"DESCRIPTIONOFMATERIALSORSERVICES‐Chargesmustbeitemized.Inspaceprovidedinthebodyofthisvoucher,

showwhereapplicable:(1)datesofservicesordelivery;(2)quantities;(3)descriptionofcharges;(4)unitprice;(5)

amount.Wherelaborispartoftheservicesrendered,indicaterateper

hourandthenumberofhours.

"



CASHDISCOUNT%‐Showanydiscountsthatareallowedforpromptpayment.Cashdiscountperiodtocommence

whenclaimisreceivedbytheTownComptroller.



CLAIMANT'SCERTIFICATION‐Theclaimant'scertificationmustbecompleted.Thedateonwhichthesignaturesaffixed

mustbegiven.

Thetitleofthepersonsigningmustclearlyindicate hisrelationshiptotheclaimant,e.g.soleowner,

partner,treasurer,bookkeeper,billingclerk,etc.Notarynotrequired.



DELIVERYRECEIPTSORINVOICE‐Attachtoclaimoriginalinvoiceanddeliveryslipssignedbythem unicipalemployee

receivingthematerials.



RETURNCLAIMVOUCHERAND

ORIGINALINVOICEPROMPTLY‐Inordertoexpeditepayment,thisclaimvoucherand

originalinvoiceshouldbereturnedpromptlytothereceivingdepartmentafterthematerialshavebeenfurnishedor

serviceshavebeenrendered.

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