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~. ~ ~ , ~~" 1 `' ./ 1 7 <br />! <br />'. And~~~ri SQ'~i]~l Rubber Stamps - D~'scounted <br />Sma// Signs / Namep/ates <br />~'`~;ru~p'~~ii%i -~ i~v~iis'i.~rN~ <br />T~rpesetring / Lpyotit Design <br />Discount Catalo : www.andersonqraphic com M~~~s~ ~'a~puter Programming <br />P.O.Box 70, Salem, Oregon 97308 Web Page App/ications <br />Phone:503/585-2528 Fvc:503/585-2528 E-Mail: jerry@andersongraphic.com <br />Bill To: Marion County General Services <br />3150 Lancaster Dr. NE <br />Salem OR 97305 <br />INVOICE <br />2253 <br />December 28, 1998 <br />Ship To: Marion County General Services <br />3150 Lancaster Dr. NE <br />Salem OR 97305 <br />Dave Mofin I 2253 I MARCO I Jerry Anderson 28-Dec-98 30-Dec-98 30-Dec-98 Hand <br />012 1 Line 2" wide Stamp Pending/PrescriberCoF <br />Id100 Ideal 100 Self Ink Black Self Inkers <br />022 2 Line 2" wide Stamp InformedConsenUPCP <br />Please Pay From This Invoice <br />~~~-~~LCZiY"~ G~~i ~~~~'~2~./ <br />/~~ <br />>y/Case 3 $5.83 30% <br />5 $8.29 30% <br />2 $8.14 30% <br />Remarks: Subtotal: <br />190-39-200 190400 Shipping: <br />Total: <br />Stamp Facsimile <br />Pending INFORMED CONSENT <br />Case Coordinator Co PCP <br />py INFORMED CONSENT <br />Prescriber Copy PCP <br />POR# SCANNE ~.~ ~ <br />~UDGET# <br />G''~`'T~# 5~, to 1 <br />Ph~.~~ ~-~T# <br />DATE ~T ~-1 1~- 5~_ DATE RTF <br />APPRCIV~~'S INITIALS _ <br />lliscount Catalog <br />www. andersongraphic. com <br />Call if you heed WEg P~4GE ffelp! <br />~ <br />$1224 <br />$29.01 <br />$11.40 <br />$52.65 <br />$0.00 <br />$52.65 <br />