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<br /> LN Tran Dept R/Org Number U ne Dept Approp Sub Org s!Orgb• Obi Pry .1'v
<br /> 40 10
<br /> 1 S L 0 3 6 4 C 0 1 E L D 9 1 Fip] 013 19114 1 PL I
<br /> l'r0 l l r el Rp Fut B e t Payment Reference Number Description
<br /> MSA4 Lite # Disc Date of Sen-ice Quantity Line Amount I/D PIF
<br /> 0 0 4 00 .
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<br /> TO THE COMPTROLLER OF THE COMMONWEALTH OF MASSACHUSETTS: INSTRUCTIONS T
<br /> I herelm-ceilIIv isiidL�r t 1 f elmItles of'peri ki •dim at Laws()f'[Ile�} gt.)%reniing dishtwwi ews ol'p b is Funds and the re ulalions thereof have been complied with and observedr
<br /> VENDOR
<br /> • Director - Fi l l i�� �� cled ci rc��
<br /> Prepared i � r Title, Date: 0 Direct inquiries to State
<br /> or aniz4alion "
<br /> nlered N-• _ _ _..� Title: - Date: Pagc or
<br /> Thea arFi lein e d a u i h jrued Sig?r41to,r1'{rj)j�roi-jng this docunjent certifies rhar lhis docu"Ienr and ani airc7L'hmetiis rare accurate and co nip le re and compt,-ith all applicable genera an special laws a)id reg uIn(joiis
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