VOUCHER
	TOWN OF BOSTON					Purchase Order No.
	8500 BOSTON STATE ROAD					DO NOT WRITE IN THIS BOX
	BOSTON, NY 14025					Date Voucher Received
	Phone (716)-941-6113		Fax (716)-941-6116			FUND - APPROPRIATION			AMOUNT	____________________ VOUCHER NO.
	www.townofboston.com
CLAIMANT'S
NAME
AND						TOTAL
ADDRESS
Terms						Vendor's Ref. No.
Dates	Quantity	Description of Materials or Services							Unit Price	Amount
									TOTAL
CLAIMANT'S CERTIFICATION
I, ____________________________________________________________________, 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 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.
DATE			SIGNATURE						TITLE
(Space Below for Municpal Use)
DEPARTMENT APPROVAL
The above services or materials were rendered or funished to
the municipality on the dates stated and the charges are correct.
DATE		AUTHORIZED OFFICIAL