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Ds 2076 Form
To
ITEM
NUMBER
Account
QTY
ARTICLES OR SERVICES
UNIT PRICE
COST
PER
AMOUNT
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Signature of Ordering Officer
Title
I Certify That the Ordered Items Listed were Received
Total
Amount
0.00
Availability of Funds
Date (mm-dd-yyyy) Except as Follows
On
PAYMENT
Complete
Amount Billed, as Per Attached Bill(s)...
Differences
Partial
Signature of Receiving Officer
Final
0.00
Amount Verified Correct For...
Pursuant to Authority Vested in Me, I certify...
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