Fillable Claim Voucher PDF (Town of Brookhaven)

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Claim Voucher PDF (Town of Brookhaven)

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BROWSE TOWN OF BROOKHAVEN (NY) FORMS

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Town of Brookhaven
Long Island
Department of Finance
Accounts Payable Section
One Independence Hill
Farmingville, NY 11738
Claim VouCher
Tel (631) 451-6680 Fax (631)451-6692
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Vendor No
G/L Account Description Amount
PAYEE CERTIFICATION: I certify that the above bill is just, true and correct;
that no part thereof has been pain except as stated; that the balance is actually due
and owing an that taxes from which the Town is exempt are excluded.
DEPARTMENT CERTIFICATION: I hereby certify that the materials speci-
ed above have been received by me in good condition without substitution; that
the services have been properly performed to my satisfaction; that the quantities
have been veried; and that the payment is approved.
Payees Signature in ink
Date Title
Commissioner’s or Department Head’s Signature in ink
Date Title
Department of Finance
Approved for Payment
Reviewed
Contract Compliance
T.B.R. Compliance
Veried
Check Date
Page
Voucher No Check No.
Invoice Number Invoice Date
Description Due Date Total Amount
PO Number Warrant Status
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Claim Voucher PDF (Town of Brookhaven)

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Completed 15 July 2020

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