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C 19'1 <br />Page: 1 Document Name: Kimberly N , <br />FUNCTION: DOCID: PV PKA 08000000275 11/26/07 02:50:36`PM <br />STATUS: PEND3 BATID: ORG: <br />H- PAYMENT VOUCHER INPUT FORM <br />PV DATE: 11 26 07 ACCOUNTING PRD: 05 08 BUDGET FY: 08 <br />ACTION: E PV TYPE: 1 SCH PAY DATE: <br />OFF LIAB ACCT: FA IND: DOCUMENT TOTAL: 41.42 <br />CALC DOC TOTAL: 41.42 <br />VENDOR CODE: 800000953 A CHECK CATEGORY: P K SINGLE CHECK FLAG: Y <br />VENDOR NAME: ECO RX <br />DBA: <br />ADDRESS: PO BOX 88 <br />CITY: AUSTIN ST: CO ZIP: 81410 <br />ACCOUNT NUMBER: <br />SELLER: FUND: AGENCY: ORG: <br />SUB -ORG: APPR CODE: PROGRAM: <br />FUNCTION: OBJECT: SUB -OBJ: <br />REV SRC: SUB -REV: BS ACCT: <br />GBL: RPTG CAT: JOB NO: <br />OFF REC ACCT: <br />H- - *S403 -READY FOR APPROVAL 3 <br />4 -0 1 Sess -1 192.136.70.50 5/17 <br />Entered � � i I`6uo �� <br />"I �- <br />Approved <br />Date <br />i CERTIFY THAT I HAVE RECEIVED kND <br />INSPECTED THE ARTICLES LISTED <br />HEREON THAT THEY ARE IN GOOD <br />CONDITION AND COMPLY WITH THE <br />SPECIFICATIONS GIVEN EXCEPT AS <br />NOTED, OR THAT THE SERVICES ARE <br />SATISFACTORY, EXCEPT AS NOTED <br />Name: KAS - Date: 11/26/07 Time: 14:50:23 <br />