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/LE I ou4- ~ i o n~ <br />~c ~~ ~~ <br />~1~~5 <br />MARION COUNTY TELEPHONE ADD, MOVE AND CHANGE ORDER <br />DEPARTMENT $ ~ ~(~dA~ S CONTACT PERSON <br />LOCATION CONTACT PHONE NR <br />Building, Floor, Room, etc <br />BUDGET <br />PROJECT TYPE OF PHONE <br />SL1,Tap,Button <br />Description of add, move or change request: <br />_ ~etac~ te ~ - ~ ~ro ~ ~02 ~2~~ vs Ph c~ ~~ i . `N ~ S <br />i ~ A~T Ac <br />AUTHORIZED SIGNATURE DATE <br />______________==-~_i=====__=____________________________________ <br />WORK PERFORMED: ~~ J,~ ,j'r l~ "'~ ~~QQ~ ~~~'V ~/~ ~~' _ <br />~ /~~SG'~~'~p"~ _ <br />TECHNICTAN'S TIME <br />Date Start Stop HRS MATERIALS Qty Cost <br />'~ 3 ~ _ <br /> <br /> <br /> <br /> <br />SUBTOTAL ~ ~ SUBTOTAL <br />~/~ <br />._ /~ Work completed Yes No <br />/~,~ Extens ion NRs ' sued : <br />Technician's Signature <br />Department verification of work performed <br />Department Signature Date <br />FORM MC 11-PP26 REV 10/88 <br />White - Invoice Yellow -~ Vendor Pink - Department <br />