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HP-8-20M · COMMONWEALTH OF KENTUCKY  
· STANDARD INVOICE YM *¤*<>*·=·= N¤·—-— -·-—--------- —--—-————-———
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. Delivered -··-··--------- - -------·------·.--- i:-L-if-iii ·~--- V -:52;, --·· 325;:. .............................. .. ............................................................. Copy frgm Purghagg Ordgr gr Cunlrgct
Intl->;;·i_; 1,1, ,]_ II.; ~_·,q»—. .J Account No. .. 'iU;¤Ll........--...-..»..~
Name and Address of Vendor .........,....... Ei ....... i ....... { .....; ___,_ 5;.}] _____ ; .;; _r_,_____ G ____ g ___ __________________.___,________,________, copy from Puréfan Order or contract
_ - ........   ....................................   ......................_._....__,.,....,...»..,.,,.......................................... T°rm° ‘‘‘‘‘‘‘‘· T ‘‘‘‘‘‘‘‘ T ‘‘‘‘‘ T ‘‘‘‘ T’TT‘TT“ ‘`‘‘'‘‘`‘` T
~ -··---··-·-·- — ·-·· ~ -··- ~ -·--··---------·---·—··-···------·-·----·—··--·- I ·-·-------—-—-—-·-··—~—-·-—-···-—·—-···----------- — ········--—---···----·-----—------···-··· VENDOR LEAVE BLANK
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C0d• Amount Code Amount X?nu;::tr {gm "`“"""""`°`°`~`."_"—""*"_—
, _ Encumbrance
____ Llquldatlon $ ........... ... .... ......................
Quantity Unit DESCRIPTION Unit Price Amount I§?::I: i
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TOTAL AMOUNT x£;]_;$_©O
VENDOR LEAVE BLANK
VENDOR'S CERTIFICATION
DI t .,..., ..,..... ...........- ..... ..." ............................... - ..... e..-...
I hereby certify that the commodities specified above have been Scoun
furnished to the commonwealth of Kentucky; that the quaiity and prices Net Amount _____________________________________________________ _ ________ _ _____ _ ______ __
conform to the proposal and purchase order or (contract; and that pay- checked with Purchase
ment, in whole or lh part, has not cén l‘€C€lV6 - Order or contract  
_ _ I Checked with
Sign.; fn"  R°°°"""° R°"°"* "'°“ ·························································· TT
By     CEO L JL   Extensions and Additions Checked...e ................I... .. .............
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VENDOWS COPY SEE INSTRUCTIONS ON REVERSE SIDE