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Town of Throop Claim Submittal Form Department Approval The above services or materials were rendered or furnished to the municipality on the dates stated and the charges are correct. Claimaint's name Claimaint's Address Signature of Authorized Offiicial Date Department Abstract Voucher Fund Appropriation Amount Total Amount $ 1. 2. 3. 4. 1. 2. 3. 4. Dates Quantity Unit Price Amount Description Total Amount $ Approval for Payment This claim is approved and ordered paid from the appropriations indicated above. Signature of Authorized Offiicial Date Signature of Authorized Offiicial Date Signature of Authorized Offiicial Date Signature of Authorized Offiicial Date Signature of Authorized Offiicial Date Road Address City/Town State Zip Code 5. 5. Print Form