_GENERAL DOCUMENTS - C1981017 ‎(316)‎

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Name: Bid Documents ‎(IMP)‎
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

Form 150(Red.4/95) STATE OF COLORADO
MISC,PLLANEOUS;EXPANSE ITEMS
DEPARTMENT i DIVISION OR AGENCY ,M' / � � _� -FOR PERIOD ENDING
19
PAYEE s, MAIL ADDRESS ���+u� v SOCIAL SECURITY NUMBER
ilan 7- Q I 4JCt C—S r Y — "2(ie—�lU
MONTH OF U e /C1 -S MONTH OF
ITEM a TELEPHONE ITEM
TELEPHONE-------- ------- -------- ------- ------- ---------ap ti - ---- ------- -------- --------
bec Oct
DAY ' s 6 3 DAY
1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
ii 11
12 12
13 13
14 14
15 15
16 16
17 17
1Q 18
19 19
20 20
21 21
29 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
TOTAL Z D3 �r TOTAL
SUB TOTAL SUB TOTAL
1 hereby certify that the above is a true state-
ment of expenses 'nc rred by me in the service /, GRAND(TO/TAL
Of ��Department. PAYEE SIGNA E L OL DATE, F
�O. IA 1�
OP'LEA E PAY BY ELECTRONIC FtsiVt)s TRANSFER ❑ESTABLISH RE n FOR EFC sEE THE:REVERSE SIDE FOR INSTRUCTIONS
ECOMMENDED FOR APPROVAL
FISCAL OFFICER SUP VISOR EXECUTIVE DIRECTOR
FUND AGCY ORG —SUB APPROP PROG FUNC OBJ —SUB I B/S G ETL RPTG JOB/PROG AMOUNT
PiC 3 3/ .to
395-53-01-1501(R 4/95) TOTAL
Sa560�i 0-