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On Facilities; or, Patient Care Facilities 1515 Holcombe Blvd., Houston, Texas 77030-4095 Attention: Insert Name of Project Manager STATEMENT FOR ARCHITECTURAL / ENGINEERING SERVICES Statement No. for the Month of Application is made for payment, as shown below, in connection with the U.T. M.D. Anderson Cancer Center Project identified above. Information in support of this application is attached. A B Amount Due this Period Invoice Items Fee A B Balance Remaining Basic Services Addit.

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