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doc11644 18792.pdf
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1 · FIGURE
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"text": "VOUCHER COPY - SIGN AT X AND RETURN TO THE PURCHASING DEPARTMENT WITH YOUR INVOICE VENDOR'S CERTIFICATION & DECLARATION I do solemnly declare and certify under the penalties of the law that the within bill is correct in all its particular; that the articles have been furnished or services rendered as stated therein; that no bonus has been given or received by any person or persons within the knowledge of this claimant in connection with the above claim; that the amount therein stated is justly due and owing; and that the amount charged is reasonable one. X CLAIMANT TITLE DATE TAX I.D. OR SOCIAL SECURITY NO. INCORPORATED? □ YES □ NO",
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Page 3
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1 · FIGURE
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