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Rtment or Establishment Paid By BUREAU OR OFFICE LOCATION OF TRANSMITTING OFFICE AGENCY STATION NO. APPROPRIATION SUMMARY VOUCHER NO. PAYEE, AND IF NECESSARY, ADDRESS, INVOICE NO. OR OTHER IDENTIFICATION AMOUNT D. O. CHECK NO. GRAND TOTAL Pursuant to authority vested in me, I certify that the items listed herein are correct and proper for payment from the appropriation(s) designated heron or on supporting vouchers. (Date) (Authorized Certifying Officer) USAPPC V1.00.

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