Beruflich Dokumente
Kultur Dokumente
10/08/14
1 10/19/12 9280 $23,821.40 23,821.40 1010 90591 54930 P452940
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23,821.40 23,821.40
ORIGINAL INVOICE(S) MUST BE ATTACHED
Account
$23,821.40
Lamphier-Gregory
1944 Embarcadero
10/01/12
64428
510-238-3550
Devan Reiff, Strategic Planning
2012-2013
See attached invoice and statement.
Fund
Project
Fourth payment for "Coliseum
City" consulting --8/18 to 9/14
Org
\
Planning, Building & Neighborhood
Preservation
Amount
Oakland, CA 94606
L
i
n
e
#
3-1201
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND HAVE BEEN DELIVERED
OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
City of Oakland
DIRECT PAYMENT REQUEST
DETAILED DESCRIPTION
AGENCY/DEPARTMENT
AUTHORIZATION SIGNATURE AND DATE (REQUIRED)
DATE
Invoice Date
MM/DD/YY
Invoice Amount Invoice Number
Customer or
Account
Number
Date Invoice
Received
MM/DD/YY
Invoice Total Amount Total
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
BATCH NUMBER
BATCH DATE
INPUT/AUDITED BY:
TOTAL INVOICE
AMOUNT
DISTRIBUTION (Check Box):
HOLD FOR PICKUP
ATTACHMENT
MAIL
Description (50 Characters Maximum )
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12
IP50
ORIGINAL INVOICE(S) MUST BE ATTACHED
$23,821.40
Program
See attached invoice and statement.
\
FMA 03/28/12
10/08/14
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9
Fund
Project
\
Amount Org
Account
$0.00
L
i
n
e
#
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND HAVE BEEN DELIVERED
OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
City of Oakland
DIRECT PAYMENT REQUEST
AGENCY/DEPARTMENT
AUTHORIZATION SIGNATURE AND DATE (REQUIRED)
DATE
Invoice Date
MM/DD/YY
Invoice Amount Invoice Number
Customer or
Account
Number
Date Invoice
Received
MM/DD/YY
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
BATCH NUMBER
BATCH DATE
INPUT/AUDITED BY:
TOTAL INVOICE
AMOUNT
DISTRIBUTION (Check Box):
HOLD FOR PICKUP
ATTACHMENT
MAIL
Description (50 Characters Maximum )
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12 Page 3 of 28
10/08/14
Fund Project
\
Amount Org
Account
$0.00
L
i
n
e
#
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND HAVE BEEN DELIVERED
OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
City of Oakland
DIRECT PAYMENT REQUEST
AGENCY/DEPARTMENT
AUTHORIZATION SIGNATURE AND DATE (REQUIRED)
DATE
Invoice Date
MM/DD/YY
Invoice Amount Invoice Number
Customer or
Account
Number
Date Invoice
Received
MM/DD/YY
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
BATCH NUMBER
BATCH DATE
INPUT/AUDITED BY:
TOTAL INVOICE
AMOUNT
DISTRIBUTION (Check Box):
HOLD FOR PICKUP
ATTACHMENT
MAIL
Description (50 Characters Maximum )
Fiscal Year
CITY, STATE , ZIP
10
11
12
13
14
15
- -
ORIGINAL INVOICE(S) MUST BE ATTACHED
DETAILED DESCRIPTION
Invoice Total Amount Total
FMA 03/28/12 Page 4 of 28
Program
\
$0.00
FMA 03/28/12 Page 5 of 28
Program
\
$0.00
ORIGINAL INVOICE(S) MUST BE ATTACHED
FMA 03/28/12 Page 6 of 28
10/08/14
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- -
Invoice Date
MM/DD/YY
PO # Invoice Amount Invoice Number
INPUT/AUDITED BY
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
ORIGINAL INVOICE(S) MUST BE ATTACHED
$0.00
FASDFS
Release Line
Amount
L
i
n
e
#
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
DETAILED DESCRIPTION
AGENCY/DEPARTMENT DATE AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Invoice Total
Total
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12
-
ORIGINAL INVOICE(S) MUST BE ATTACHED
$0.00
FASDFS
CA BOE
Sales Tax
FMA 03/28/12
10/08/14
1
2
3
4
5
6
7
8
9
INPUT/AUDITED BY
$0.00
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO # Invoice Amount
Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12 Page 9 of 28
10/08/14
INPUT/AUDITED BY
$0.00
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO # Invoice Amount
Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
10
11
12
13
14
15
16
- -
ORIGINAL INVOICE(S) MUST BE ATTACHED
DETAILED DESCRIPTION
Invoice Total
Total
FMA 03/28/12 Page 10 of 28
$0.00
CA BOE
Sales Tax
FMA 03/28/12 Page 11 of 28
$0.00
CA BOE
Sales Tax
-
ORIGINAL INVOICE(S) MUST BE ATTACHED
FMA 03/28/12 Page 12 of 28
10/08/14
1
2
3
4
5
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7
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9
INPUT/AUDITED BY
Invoice Number
Invoice Date
MM/DD/YY
PO # Invoice Amount Release Amount Line
L
i
n
e
#
TOTAL INVOICE
AMOUNT
$0.00
BATCH NUMBER
BATCH DATE
2012
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12 Page 13 of 28
10/08/14
INPUT/AUDITED BY
Invoice Number
Invoice Date
MM/DD/YY
PO # Invoice Amount Release Amount Line
L
i
n
e
#
TOTAL INVOICE
AMOUNT
$0.00
BATCH NUMBER
BATCH DATE
2012
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
10
11
12
13
14
15
16
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18
FMA 03/28/12 Page 14 of 28
10/08/14
INPUT/AUDITED BY
Invoice Number
Invoice Date
MM/DD/YY
PO # Invoice Amount Release Amount Line
L
i
n
e
#
TOTAL INVOICE
AMOUNT
$0.00
BATCH NUMBER
BATCH DATE
2012
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
19
20
21
22
23
24
25
- -
ORIGINAL INVOICE(S) MUST BE ATTACHED
DETAILED DESCRIPTION
Invoice Total
Total
FMA 03/28/12 Page 15 of 28
CA BOE
Sales Tax
$0.00
FMA 03/28/12 Page 16 of 28
CA BOE
Sales Tax
$0.00
FMA 03/28/12 Page 17 of 28
CA BOE
Sales Tax
$0.00
-
ORIGINAL INVOICE(S) MUST BE ATTACHED
FMA 03/28/12 Page 18 of 28
10/08/14
1
2
3
4
5
6
7
8
9
INPUT/AUDITED BY
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
$0.00
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO #
Invoice Amount Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
FMA 03/28/12 Page 19 of 28
10/08/14
INPUT/AUDITED BY
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
$0.00
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO #
Invoice Amount Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
10
11
12
13
14
15
16
17
18
FMA 03/28/12 Page 20 of 28
10/08/14
INPUT/AUDITED BY
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
$0.00
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO #
Invoice Amount Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
19
FMA 03/28/12 Page 21 of 28
10/08/14
INPUT/AUDITED BY
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
$0.00
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO #
Invoice Amount Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
20
21
22
23
24
25
26
27
FMA 03/28/12 Page 22 of 28
10/08/14
INPUT/AUDITED BY
BATCH NUMBER
BATCH DATE
TOTAL INVOICE
AMOUNT
$0.00
Amount Line
L
i
n
e
#
Invoice Number
Invoice Date
MM/DD/YY
PO #
Invoice Amount Release
IF INVOICE IS DISPUTED
put an X in the box
IF SUPPLIER IS SUBJECT TO
PROMPT PAYMENT
put an X in the box
SUPPLIER NUMBER
SUPPLIER NAME
ADDRESS
I HEREBY CERTIFY THE ARTICLES OR SERVICES DESCRIBED BY THE INVOICE(S) ATTACHED AND LISTED BELOW WERE NECESSARY FOR USE BY THIS AGENCY / DEPARTMENT AND
HAVE BEEN DELIVERED OR PERFORMED AND THAT NO PRIOR CLAIM HAS BEEN PRESENTED FOR SAID ARTICLES OR SERVICES:
PAYMENT REQUEST PREPARED BY
HOLD FOR PICK-UP
City of Oakland
ENCUMBRANCE LIQUIDATION
AGENCY/DEPARTMENT DATE
AUTHORIZATION SIGNATURE AND DATE REQUIRED
Date Invoice
MM/DD/YY
Received
Customer or
Account
Number
Description (45 Characters Maximum)
DISTRIBUTION (Check Box):
ATTACHMENT
MAIL
PHONE NUMBER (REQUIRED) PRINTED NAME OF AUTHORIZATION SIGNATURE
Fiscal Year
CITY, STATE , ZIP
28
29
30
31
32
- -
ORIGINAL INVOICE(S) MUST BE ATTACHED
DETAILED DESCRIPTION
Invoice Total
Total
FMA 03/28/12 Page 23 of 28
$0.00
CA BOE
Sales Tax
FMA 03/28/12 Page 24 of 28
$0.00
CA BOE
Sales Tax
FMA 03/28/12 Page 25 of 28
$0.00
CA BOE
Sales Tax
FMA 03/28/12 Page 26 of 28
$0.00
CA BOE
Sales Tax
FMA 03/28/12 Page 27 of 28
$0.00
CA BOE
Sales Tax
-
ORIGINAL INVOICE(S) MUST BE ATTACHED
FMA 03/28/12 Page 28 of 28