AFFIDAVIT OF IDENTITY AND RECEIPT OF FILING PLEASE COMPLETE SECTIONS I, II, III AND IV BELOW (Print or Type) – See Reverse Side for Important Notifications OFFICE USE ONLY

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DIRECT COST REVIEW-JUSTIFICATION: PLEASE COMPLETE THIS FORM FOR JUSTIFICATION OF QUESTIONABLE DIRECT COSTS Provide the information below, plus any related attachments (copy of receipt, quote, etc). Department: RESET

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Page 1 of 2 SAMPLE INSPECTION FORM SHIPPING CONTAINER RECEIPT

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WASHINGTON COUNTY OREGON June 23, 2015 Notice of Receipt of Ballot Title

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Appeal Request Form All requests for appeal must be submitted to MenuTrinfo headquarters within 30 days of the original incident. This will be reviewed and a final decision made within 30 days of MenuTrinfo’s receipt o

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無床版 レセプト請求に必要な機能を満載！ いくつものチェック表示機能により、入力を最小限にし、ミスの削減 

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SIGMOD 2013 – Call for Workshop Proposals http://www.sigmod.org/2013/calls.shtml Several workshops are held together with the annual SIGMOD/PODS conference. The deadline for the receipt of proposals for SIGMOD-sponsore

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WASHINGTON COUNTY OREGON April 17, 2015 Notice of Receipt of Ballot Title

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ACKNOWLEDGMENT OF ORDER AND TERMS AND CONDITIONS OF SALE This is to acknowledge receipt of your ("Buyer") purchase order for the specified products (the "Products") of ELANTAS PDG,INC. ("Seller") and to set forth the ter

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*For Your Safety and Enjoyment, Please Read This Information.* TICKETS ALCOHOL CONSUMPTION Bring your original PICKUP RECEIPT to the gate listed on your receipt. A

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