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Get NY AC 92 1994-2024

AC 92 Rev 6-94 STATE VOUCHER OF STANDARD VOUCHER NEW YORK Originating Agency Orig. Agency Code NYS Environmental Conservation Payment Date MM DD Payee ID YY Additional Interest Eligible Y/N 09000 OSC Use Only Liability Date Zip Code Route Payee Amount IRS Code IRS Amount Payee Name Limit to 30 spaces Stat. Type Statistic Address Limit to 30 spaces Ref./Inv. No. Limit to 20 spaces Ref./Inv. Date Indicator Dept. Purchase Order No. and Date State Indicator -Statewide / Limit to 2 MIR Date MM DD YY City Limit to 20 spaces spaces P-Contract Y Description of Material/Service If items are too numerous to be incorporated into the block below use Form AC 93 and carry total forward Quantity Unit Price Payee Certification I certify that the above bill is just true and correct that no part thereof has been paid except as stated and that the balance is actually due and owing and that taxes from which the State is exempt are excluded. Amount Total Discount Payee s Signature in Ink Title Date Name of Company Net FOR AGENCY USE ONLY Merchandise Received STATE COMPTROLLER S PRE-AUDIT Verified Authorized Signature Page No. by Audited Expenditure Accum Object Cost Center Code Dept Certified For Payment of Net Amount rendered or furnished are for use in the performance of the official functions and duties of this agency. AC 92 Rev 6-94 STATE VOUCHER OF STANDARD VOUCHER NEW YORK Originating Agency Orig. Agency Code NYS Environmental Conservation Payment Date MM DD Payee ID YY Additional Interest Eligible Y/N 09000 OSC Use Only Liability Date Zip Code Route Payee Amount IRS Code IRS Amount Payee Name Limit to 30 spaces Stat. Type Statistic Address Limit to 30 spaces Ref*/Inv* No* Limit to 20 spaces Ref*/Inv* Date Indicator Dept. Purchase Order No* and Date State Indicator -Statewide / Limit to 2 MIR Date MM DD YY City Limit to 20 spaces spaces P-Contract Y Description of Material/Service If items are too numerous to be incorporated into the block below use Form AC 93 and carry total forward Quantity Unit Price Payee Certification I certify that the above bill is just true and correct that no part thereof has been paid except as stated and that the balance is actually due and owing and that taxes from which the State is exempt are excluded* Amount Total Discount Payee s Signature in Ink Title Date Name of Company Net FOR AGENCY USE ONLY Merchandise Received STATE COMPTROLLER S PRE-AUDIT Verified Authorized Signature Page No* by Audited Expenditure Accum Object Cost Center Code Dept Certified For Payment of Net Amount rendered or furnished are for use in the performance of the official functions and duties of this agency. Varr Yr Statewide Special Approval as required Liquidation Orig. Agency OSC By Line F/P Q Check if Continuation form is attached. AC 92 Rev 6-94 STATE VOUCHER OF STANDARD VOUCHER NEW YORK Originating Agency Orig. Agency Code NYS Environmental Conservation Payment Date MM DD Payee ID YY Additional Interest Eligible Y/N 09000 OSC Use Only Liability Date Zip Code Route Payee Amount IRS Code IRS Amount Payee Name Limit to 30 spaces Stat. Type Statistic Address Limit to 30 spaces Ref*/Inv* No* Limit to 20 spaces Ref*/Inv* Date Indicator Dept. .

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