VOUCHER FOR PAYMENT – FOOD SERVICE Park County School District #6 919 Cody Avenue, Cody, WY 82414

Phone: (307)587-4285

Federal Tax Exempt #A-198420

Fax: (307)527-5762

State Tax Exempt #11-0-00187

Payable to: __________________________________ Address:

__________________________________ __________________________________

_____________________________________________________________________________________ DESCRIPTION OF SUPPLIES OR SERVICE_________________________________________AMOUNT ___ LUNCH ACCOUNT REFUND /STUDENT NAME: ______________ _________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I certify, under penalty of perjury, that this statement and the items included therein for payment are correct and just in all respects.

Signed _____________________________________

Date_________________________________

POST TO:

INVOICE # PLEASE RETURN VOUCHER TO FOOD SERVICE DEPARTMENT FOR CODING AND APPROVAL.