Attch_6 _DD1149.doc
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- Solicitation number
- HSTS04-13-R-CT3025
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Attachment 6 DD1149 Form
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REQUISITION AND INVOICE/SHIPPING DOCUMENT
Form Approved OMB No. 0704-0246
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302 and to the Office of Management and Budget. Paperwork Reduction Project (0704-0246)., Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN COMPLETED FORM TO THE ADDRESS IN ITEM 2
1. FROM: (Include Zip Code)
| SHEET NO. |
| NO. OF SHEETS |
| 5. REQUISITION DATE |
| 6. REQUISITION NUMBER |
| 1 |
| 1 |
| 7. DATE MATERIAL REQUIRED |
| 8. PRIORITY |
| 2.: TO: (Include ZIP Code) |
| 9. AUTHORITY OR PURPOSE |
| 10. SIGNATURE |
| 11a VOUCHER NUMBER & DATE |
Annette Cuyler
| 3. SHIP TO: MARK |
| 12. DATE SHIPPED |
| b. |
| 13. MODE OF SHIPMENT |
| 14. BILL OF LADING NUMBER |
15. AIR MOVEMENT DESIGNATOR OR PORT REFERENCE NO.
| 4. APPROPRIATIONS SYMBOL AND SUBHEAD |
| OBJECT CLASS |
| EXPENDITURE ACCOUNT |
(From) (To)
| CHARGEABLE ACTIVITY |
| BUREAU CONTROL ACTIVITY NO. |
| BUREAU CONTROL NO. |
| AMOUNT |
| ITEM NO. |
| FEDERAL STOCK NUMBER, DESCRIPTION AND CODING OF MATERIEL AND/OR SERVICES |
| UNIT OF ISSUE |
| QUANTITY REQUESTED |
| SUPPLY ACTION |
| TYPE |
CON- TAINER
| CON-TAINER NOS |
| UNIT PRICE |
| TOTAL COST |
| (a) |
| (b) |
| (c) |
| (d) |
| (e) |
| (f) |
| (g) |
| (h) |
| (i) |
1.
| EA |
| 1 |
| Est. |
| Est. |
| 16. TRANSPORTATION VIA MATS OR MSTS CHARGEABLE TO |
| 17. SPECIAL HANDLING |
18.
RECAPIT-ULATION
| ISSUED BY |
| TOTAL CON-TAINERS |
| TYPE CON-TAINERS |
| DESCRIPTION |
| TOTAL WEIGHT |
| TOTAL CUBE |
| 19. |
RECEIPT
| CONTAINERS RECEIVED EXCEPT AS |
| DATE |
| BY |
| SHEET TOTAL |
| OF SHIP-MENT |
| A. Cuyler |
NOTED
CHECKED BY
| QUANTITIES RECEIVED |
| DATE |
| BY |
| GRAND TOTAL |
EXCEPT AS
NOTED
PACKED BY
| POSTED |
| DATE |
| BY |
| 20. RECEIVER’S |
VOUCHER NO.
File details come from the government source that posted it. Updated .