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E <br /> 1 <br /> I <br /> DOCUMENT ID <br /> THE COMMONWEALTH OF MASSACHU <br /> TS DEPT R/ORG NUMBER PV DATE ACCTG PRD BUD FY COMPTROLLER'S DIVISION <br /> — _ <br /> F(A) 3C06 <br /> 0 1 D q-,q y, o PAYMENT VOUCHER INPUT FOR <br /> (E) SCH PAY DATE OFF LIAB ACCT VENDOR'S CERTIFICATION: <br /> .. (M) "I certify that the goods were shipped or the DEPARTMENT/ORGANIZATION NAME <br /> service rendered as set fort below. <br /> h, <br /> En V. ka") En (. -1�IV, v_( r� <br /> /ria e G�s! <br /> ,,. "VENDOR NAME AND ADDRESS <br /> DOCUMENT TOTAL: rDEPT VENDOR INVOICE NUMBER VENDOR CODE: ,7f�"`'` l) T rzeaj1-e t- <br /> Flit' oyj- 60i— EMP ee <br /> REFERENCED ORDER LINE QUANTITY DESCRIPTION <br /> UNIT PRICE AMOU <br /> w <br /> I <br /> c � I <br /> 1 <br /> 0 1 <br /> W I <br /> � I <br /> z <br /> 1 <br /> a . <br /> I <br /> y I <br /> I <br /> li'i 1 <br /> X I <br /> m <br /> O 1 <br /> Ua I <br /> 3 I <br /> N I <br /> 1 <br /> I <br /> 1 <br /> W REFERENCED ORDER <br /> I <br /> m LN TRANS DEPT R/ORG NUMBER LINE DEPT APPROP SUB ORG S/ORG OBJ S/OBJ PROG TY PROJ/CL/GR <br /> 6► FwE 36ao a1 Fig E �� - o�6 , <br /> RPTG FUND BS ACCT DEPT VENDOR INVOICE NUMBER: DESCRIPTION: <br /> DISC DATES OF SERVICE QUANTITY AMOUNT: I/D P/F <br /> TO <br /> TO THE COMPTROLLER OF THE COMMONWEALTH OF MASSACHUSETTS: <br /> I hereby certify under the penalties of perjury that all laws of the Commonwealth governing disbursements of <br /> public funds and the regulations thereof have been complied with and observed. ,c <br /> PREPARED BY: DATE: <br /> TITLE: fi1L —T^ INSTRUCTIONS TO VENDO <br /> APPROVED BY: TITLE: FILL IN SHADED AREAS <br /> DATE: DIRECT INQUIRIES TO <br /> ENTERED BY: TITLE: STATE ORGANIZATION <br /> DATE: RETAIN GREEN COPY <br />