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2. Contact the Accounting Office with any Questions.
4. Department*
   -- Select One --Building CommissionerCommission on DisabilitiesCommunity Preservation Committee (CPC)DPW - AdministrationDPW – Building MaintenanceDPW – DrainsDPW – EngineeringDPW – FleetDPW – HighwayDPW – Parks & ForestryDPW – Recycling & Solid WasteDPW – SewerDPW – Snow and IceDPW – WaterFinance Department All DivisionsFire DepartmentHealth & Human Services - Public HealthHealth & Human Services - Senior ServicesHealth & Human Services - Veterans ServicesHealth & Human Services - Youth ServicesLegal ServicesLibraryMemorial Park TrusteesMunicipal ParkingPark & RecreationPlanning & Community DevelopmentPolice DepartmentBuilding Design & ConstructionTown ClerkTown ManagerSchool DepartmentOther (explain in the description box)
6. Purchase Order Number*
8. Vendor Name*
10. Remaining Balance*
12. Comment*
14. 
    
16. By clicking I agree below, you agree and acknowledge that 1) all the bills related to this purchase order have been received and paid 2) that funds are no longer required for the intended purpose of the purchase order 3) that no additional purchase of goods and/or services that this purchase order relates will be made without conducting a new procurement 4) that the funds are no longer required for the original purpose of the encumbrance 5) that this request will not be "Signed" in the sense of a traditional paper document and 6) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.
18. I Agree*

    1. Yes
20. Authorization Code*
22. 
    

24. Rev 12/10/2014; 09/24/2015; 11/12/2015; 05/08/2017; 08/28/2017; 01/26/2019; 08/17/2021; 02/25/2024

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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit

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