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<br />MARION COUNTY TEL?~1?HONE ADD, MOVE ANU CHANGE ORDER
<br />DEFAR~'MENT (~~ (~ ~~-"`~ ~- ~ (,: _ ~ONTACT PERSON ~'~~ f `
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<br />LOCATION ~`~!'r~~?r~~'_ ~~ ` /~ti~ `-`'' >~`~`'=~=`~~' CONTACT PHONE NR
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<br />Building, loor, Room, etc
<br />BUDGET PROJECT TYPE OF PHONE
<br />SL1,Tap~Autton
<br />Description of add, move or change request:
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<br />AUTHORIZFD SIGNATURE DATE
<br />-----------------
<br />WORK FERFORMED:_ ~;~,STArleO Lv15 ypic w•'2e Fnrc cob^-° , p~z ~ -2~toG~-r~
<br />J~ ~~ Pho,~~-s, T~~~ __04.+ ~9~ 351~~ s' 3~CRo ~`s ~ ~NAn~c3N ~03~
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<br />T~ CHNICIAN' S TIME DA6e.~/ d~•~SN
<br />Date Start Stap HRS MATERIALS Qty Co~~t
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<br />~;'RTC~TAT, ~ff~v f1/ ~ N3.S,0O SUBTOTAL___A~Y'~E~~ f~r33
<br />DATE BILLED TOTAL CHARGED ~/r~Q3 ~~~
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<br />~ Extension NR ~ sued:
<br />chnician's Sigr..ature ~,~,~SI~3S/?.
<br />Dep tment verification of work performed 3~lQO
<br />Department Signature Date
<br />FORM MC 11-PP26 REV 1C~/88
<br />WhiLe - Invoice Yellow - Vendor
<br />Pink - Department
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