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FORM CD-404-EF (09-97) I. ORDER NUMBER
U.S. DEPARTHEN'l' OF CQlHERCE
SUPPLY, EQUIPMENT OR SERVICE ORDER 43-YA-BC-490960
lCONTIIIOATIOR SHEET)
PAGE 2 OF 2
32. SUPPUER /33. ISSUING OffiCI! S. ORDER DATE IS, DATE PRINTED
MlCHELLEFRANKFURTER BUREAU OF TIlE CENSUS 0512012004 0211012005
34. 3S. 36. 37. 3S. 39. 40. 41.
UNE MDL QTY QTY FINAL FUlL ACCOUtmNG CLASSIFICATION DIST% AMOUNT
ITEM RECVD
1 1 1 040200000-000 21 10-02-07-000 11-04-0009-00-00-00-00 25·20-04-00 000000 IOOO!c 2.500.00
42 43. 44. 4S. 46. SHIP TO ADDRESS 42 43. 44. 4S. 46. SHIP TO ADDRESS
UNE MOL QTY RECEIVING (lNUUDE REFERENCE ORDER NO. UNE MOL Qrr REC£IVING (INCLUDE REFERENCI! ORDER NO.
l1EM OffiCI! CODE ON SHIPPING LABEL) ITEM OfFICE CODE ON SHIPPING LABEL)
ACCEPTANCE: I CERTIFY THAT ARTIQ.ES AND/OR SERVICES ANNOTATED S4. ACCEPTANCE SIGNATURE &: TITLE SS. ACCEPTANCE DATE
ABOVE HAVE BEEN RECEIVED, INSPECTED AND ACCEPTED AS COMPLYING
W111l TIfIS ORDER, AS OF TIlE DATE SHOWN.