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FORK CD-404-EF (09-91) I. ORDER NUMBER
11. S. DEPAR'lMEll'r OF COHIIBIlCB SUPPLY, EQUIPMENT OR SERVICE ORDER 43-YA-BC-911924
I
(COll'rINIlATIOII IlIIEET)
32. SUPPLIER 33. ISSUING OFFICI! 5. ORDER DATE 18. DATE PRINTED
PAGI! 2 OF 2
DIGITAL MEDIA GROUP BUREAU OF THE CENSUS 04/29/1999 02/1012005
34. 35. 36. 37. 38. 39. 40. 41.
UNE MDL QTY QTY FINAL FUll. ACCOUNTING CLASSIfICATION DIST% AMOUNT
ITI!M RI!CVD
42. 43. 44. 4S. 46. SHIP TO ADDRI!SS 42. 43. 44. 45. 46. SHIP TO ADDRI!SS
UNB MDL QTY RI!CI!MNG (lNCUJDI! RI!FEREHCIl ORDER NO. UNE MOL QTY RECEIVING (lNCLUD1! REI'I!RI!NCI! ORDEll NO.
ITEM OFFICI! CODE ON SHIPPING LABEL) ITEM OFFICI! CODI! ON SlUPPlNG LABI!L)
6664-0 Video duplication & lransfer scmces PH DUNTON (W)301-763-2806 Loc: FB 3 Rm: 2705
.. _51_.TYP
__ E_SHIP_MENT ....5_2._RE_CEIPT
_ _S_IG_N_A_TURE
_ _It_TI_TLE -+_53_.RE_CElPT
_ _D_A_n. --1
ACCl!PTANCI!: I CERTIFY mAT ARTIO£S AND/OR SERVICES ANNOTAlED 54. ACCEPTANCI! SIGNA1URI! k TITLE 55. ACCEPTANCI! DATE
ABOVE HAVE BEEN RECEIVED, INSPECTED AND ACCEPTED AS COMPLYlNG
WI1H 11IIS ORDER, AS OF THE DATE SHOWN.