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EFTA00227381 | EFTA00227618 EFTA00227618 tcl GENERAL et:=1 tmLli etticil Case No. 08-80736-CV-MARRA OEM 23 • FM.. if spproptiolc sty data not provided foe elrenthere on the reign mg rmortaunti at- reason for any demi amount. &Sabena P-000238 IrEntli. The Schedule and Voucher Number will be encored by the office which =moll) schedules the onproseJ amount for payment by the TriteMir) Doptirtmeat. ITEM 19 and 20 -These blocks mist be signed and dims by officio/ of the ogoonet ion whoa* tuna will be charged. Hi, or Me signature condilutes a stitement that the records to whid, the invitee area wee teamed In ollIcal busmen and ova provided by the 0nneial instnition in :earthly.* with the ordenng instruntn4 ITEM Ii • Dish the box *ha Amines the apciethorietc procedure wearied b the Act %Ouch necessitna the 'equal for financial entranton ITEM I 7 • Enter the amount anthod to bo pops Inc pry meat ITEM to - This bloth should be used to reflect any difforencca between the emoted claimed by the financial inatution andthe correct amount with reimbursed Differences may result (rout computation oink or failure aim fininciel imitation to deliver infon'netion squeal. ITEM le and O • Seli•caplanaory. SECTION C RECEIVING REPORT (To be completed by the reateeingotricsa. obenthe (equated &Nagai information he been delivered) ITEM 12 and 1 t • Self-explanuoiy. ITEM U • SelTeaplusiory. Completion of this block Caublula In itentittd bll or involve (or reimbursement for the corn inclined in prosithng the information (equated SECTION B. FINANCIAL INSTITUTION INVOICE (To be completed by the Gomel dilution). ITEM I, 9 ond 10 - SdkopleAdory. ITEM 7 - Include. if appropridc any porta nmt informattein(dated to the purthan rake not preenieJ for el arouse on die form ITEM 6 - Enter the date the financiel information is squint,. ITEM 5 • Erna the Marie and address W *high tP tourteek1 micerration to to beret. by the financial tnatnwon, This will normally be theism and addtessof the requesting official ITEM 4 - tote the Ode and mailing addies I office (*mein insulation tengreaseated to frith fourirthl iefornution. SECTION A • AUTHORIZATION AND PURCHASE ORDER OP be completed by the requesongo Moot ) ITEM 3 • Thu No& may be used to 'dandy die specific care for which the limn:lel information is rimmed. This block may be kit ITEM 2 • Self milanmar) fTEM I • A Purchase Order Numbcr will In: preproma on each twin Thu mamba wilt be mud (or reatenue putpusa on any t4nespormknee vexing to this amine rawest for fnencial lora-nation PREPARATION INSTRUCTIONS common of Imam or overdue paymerits tad Improperly takes tecomea.. Deteternmiroo or interest dm will be meth In accordant with the prorhloor of the Prompt Payment Act awl the Office •( Mmtegernenl Ind Fledge, Clroder A-12S. Tie Prompt Parasol tee Pont Law r -177,94 Sat RS al USC. I00) it appl kable to porwou under tab ponikam order aro repoirtv the payment to NOTE! Payment. ander MU purchase order will be Jue on the 3011 Caleador day eller the Jae •! snot ritelpt of • proper Invoice In the alike doiµe cal is matte the Invoice the date of ate check tuned In payment shall be nanoideral to be the date pi:40W U met. This u a melo-pumose form deign:4w term as on Ave...Inc-soon, Purchase Oder, Iterniud Invoice. Reaming Repon mid Payment voucher in coothiwoon with 'novena for firencial wilonnotion.• punuani to di. Right to inanetal Privet) AM of 1978. P.L 95-610, Tide XL 1211S C 3415 •V
April 24, 2026 at 8:16 PM