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~R~.t~oc~TzoN <br /> <br />~~ i3a~ <br />MARION COUNTY TELEPHONE ADD, MOVE AND CHANGE ORDER <br />DEPARTMENT R~~ K CONTACT PERSQN CR/L~p <br />LOCATION 5i-t^ FLpp ~t C,i,.l~ CONTACT PHONE NR ~~ 3 <br />Building, Floor, Room, etc <br />BUDGET <br />PROJECT TYPE OF PHONE SL.I Dl~T/~ <br />SLl,Tap,Button <br />Description of add, move or change request: <br />RC~',~OC/~~l° 6~,'~'~'1 ~-'C~ NeW IC~C1~+ ~~/U } phON~2 3+ /~ATR <br />AUTF~ORIZED SIGNATURE llA'1'~ <br />WORK PERFORMED: `. <br />TECHNICIAN'S TIME ~'~' <br />Date Start Stop HRS MATERIALS Qty Cnst <br />; ,,~, «,.t, - <br />~ '; ~~. i~i.~~-~.~~ ; ": <br /> <br /> <br /> <br />,_ ; .,, <br />SUBTOTAL • ~ ~:' ~ ~~ s` ~~-' <br />SUBTOTAL s.,.~ <br />~~ <br />~>C`~~. c~. ~ <br />DATE BILLED ,, TOTAL CHARGED j~ <br />~ Work completed Yes No <br />~ ~: ~~,_, ~ Extension NRs issued: <br />echnician's Signature <br />Dep~ tment verification of work performed <br />, <br />Department Signature Date <br />FORM MC 11-PP26 REV 10/88 <br />White - Invoice Yellow - Vendor Pink - Department <br />