PerFORM PRO FORM 1.01 j-R/ E . F . 7G . H . <I . JC . K .  L . < M .  NC.  PC. Q. SSJ+N+PRC. S. ''Q-RW . X 55 GGFG B . Y . T . UC . D . A . v . Swiss"System"Helvetica"DutchUnivers ATT"Univers (WN)"Times New Romans"s"s"s"Va $ il&CYfq 7#%6#Designed on PerForm Pro software.aT.>;g ;+O;OUNITED STATES DEPARTMENT OF AGRICULTUREq#&zKXXP(6P6INVOICE - RECEIPT CERTIFICATION $KZ1 B?TB>T1. PURCHASE ORDER NUMBERK(1 7Q+P6QP2. TYPE SHIPMENT (Check one) AD(KrV?1`g9J5 f953. DATE GOODS RECEIVED/ACCEPTED/ SERVICE PERIOD END DATEPrVK8?1 ' &T& ~T4. DATE INVOICE RECEIVEDqi%zܦ[<1   E QgBQfB5. VENDOR INVOICE NUMBERqz8ܦ<1   F 9_69^66. VENDOR NAMEi%ܦ80[<1  77,5 6,5I certify the items billed were received, inspected, and accepted as complying with this order except as noted below. Bill amounts are to be charged to corresponding line items on purchase order as follows:AD$0\fZ1'$wS &$vS7 P.O. LINE ITEM NO.Y015N 5N8 DESCRIPTION0ZCW19wO 9vO9 QUANTITY/ UNIT ISSUEqZC0ޛW185g5 5f510 DOLLAR AMOUNTqޛ0S1 66 667 P.O. LINE ITEM NO.0;nSi1 AP AP8 DESCRIPTION;n0|i1p-R -R9 QUANTITY/ UNIT ISSUE|081O7N O6N10 DOLLAR AMOUNTq$Y3Z$Y0  G ((Y3YT0  H /~/ZC3WXZCT0  I SSZCޛ3WZCޛ0  J --ޛ4S  ޛ%0  K  G8F8;n4Si  ;n%0  L  AA;n|4i  ;n|0  M  '5&5|84  |8D0  N  ''|L48 |L48Pn`  P _<^<;R~;R''!!EE11 V121314fault .{820  Q 7;6;15z"Jz"ZC  R EEg+f+55AA16C:\M1718Z 40  S _^19 $ xp"҅E.T0  x66 AUTHORIZED OFFICIALq҅ `ET0  v O9N921. ADDRESS 0`pE0 /E.E22. SIGNATURE`G$EY0 <<23. DATE$`Y0  W ? ,> 24. PHONE (Area Code & Number)q"`lY"`8+yC  X O N %nߗ\*Y  Q 25. Attach invoice and mail to:(Use of Window Envelope is Optional)TbY;:|8I  AA USDA, Office of Finances and Management U.S. DEPARTMENT OF AGRICULTURE NATIONAL FINANCE CENTER P.O. Box 60075 New Orleans, Louisiana 70160>l@)Z,fP{ =%=FORM AD-838-B USDA (Revised 2/91) ޛ4|P/1  OH7FNH6F+ Non-Merchandise Charge quQm1c0  5w v + Freight [nۉd0   Ag f + Federal Excise Tax Mqc0   ""+ State or Local Tax qI0  00Sub-Total-,0  88- Trade-In \Sj+^0   wQvQ- Discount q"^0  SS- Credit U%30   55TOTAL Sޛ0ޛ3ޛ383ޛ8ޛޛ!ޛ484#KwKXi%Li%r[[1Kp.ip1   B```UU`7^73  sq'%a 7M7MPARTIAL&j?p$P1  Y<<`ǀ7  ;o)pIa QFQFCOMPLETE8p$2 qZ00a$2 8RCy  Tault //QQ20. RECEIPT EXCEPTION`U>1`  C SSw7R v7R6 6SM SMMONTH 1.DAY .YEAR :.V`>1.V`V  D SSC?R C>R?SN >SNg7N f7NMONTH DAY YEAR zHmY0 OBNBFTS COMM7RbA n V>g>E*d9\da  7SO66SN643 - Wfl}  A6.  E~Ȑmg9^-E~ȐV(g0 \m90  Hڏb:e0.Hk?a80wi3zX51av0b;<   R~RG6&F61~18  ORDER NUMBER <C 43-91Y9-9-58XeM\x3/{61aMVw $  O5N5PP++7 FUND CODE  TRng P$361ap$$  PP_N^NPP5 SF- 281 N  EKЈu֘n361aЗhy;   GBFB'C$&C444  ORDER DATE   032189 u֘361aЗyd;   ---)-QQ3  CONTRACT NUMBER  OM<=u.ЈC}!2Y41a X2   _1^1?5>59  SUB '3 61aI_x  7C6CQQQ~Q2 RECEIVING OFFICE NO.  91Y9M02R^$3Z 61aX#I_x  55WQ*VQgTfT1  PAGE NUMBER   1 of 1-9IMUy.m1a7 7USE THIS FORM ONLY IF THE PURCHASE ORDER NUMBER  BEGINS WITH "43."  IF ORDER NUMBER BEGINS  WITH "40," USE EITHER  THE  GREEN "RECEIPT COPY" OF  THE PURCHASE ORDER OR THE  PARTIAL RECEIPT FORM, AD-838A.  IF ORDER NUMBER BEGINS  WITH A "41" OR "42," NO  RECEIPT REPORT IS REQUIRED. IF ORDER NUMBER BEGINS WITH A "45," USE  FORM AD-838D c"@6IWt1  00INSTRUCTIONS 3P$M3/61ap$M$  GGGG996 UNIT CODE  07t" R|iWl1 /RL.RBLOCK NUMBER 1. Enter the Purchase Order Number beginning with "43" as indicated in Block 8 of the Purchase Order. 2. If you have received only part of the order (you expect another shipment), check the "Partial" box. If this shipment completes the order, check the "Complete" box. If 5th position of receiving office number (Block 2 on Purchase Order) is an "M," you are one of several offices receiving goods or services from this order and must always check the "Partial" box. 3. Enter the date the goods or services were received and accepted or the date the service period ended. Always enter the latest date. 4. Enter the date the invoice was received. 5. Enter the Vendor's Invoice Number, If none, enter "NONE." If more than one invoice, submit a separate AD-838B for each. 6. Enter the name of the Vendor to whom payment will be made. FOLLOW BLOCK NUMBER 7 THROUGH 10 FOR EACH LINE ITEM RECEIVED. 7. Enter the appropriate line item number (as indiated in Column 12 of the Purchase Order) for the goods or service you have received and accepted. 8. Enter a brief description of the goods or service (See Column 14 of the Purchase Order). 9. Enter the quantity received and unit of issue for each line item. 10.Enter the dollar amount to be paid for each line item received. 11.Enter the total of the charges shown on the invoice which was designated as Non-Merchandise on the obligation, if payable. If not payable, enter "0" and explain in Block 20, Receipt Exception. If Non-Merchandise is not on obligation, net the amount into the line item amounts. 12.Enter the total amount charged for Freight if authorized. Postage and handling charges are considered Freight. If Freight is not authorized, enter "0" and explain in Block 20, Receipt Exception.?QPj1 N`NBLOCK NUMBER 13. Enter the total Federal Excise Tax as shown on invoice if tax charged is proper. If tax charged, but Government exempt., enter "0" and explain in Block 20, Receipt Exception. 14. Enter the total State or Local Tax as shown on invoice, if tax charged is proper. If tax charged, but Government exempt, enter "0" and explain in Block 20, Receipt Exception. 15. Enter the sum of all the dollar amount columns up to this point (including the line item amounts). 16. Enter the total amount allowed for Trade-In if Trade-In is indicated on order. If Trade-In is not on order, net the Trade-In into the line item amounts. (It may be necessary to combine amounts if more than one Trade-In given.) 17. Enter the total Line or Volume discount amount shown on the invoice if Line or Volume discount is shown on order. If Line or Volume discount is not on order, net the discount into the line item amounts. Time discounts are computed by NFC. Do not enter Time discounts here. 18. Enter the total Credit indicated on the invoice if Credit is indicated on order. If no Credit on order, net the Credit into the line item amounts. 19. Enter the total amount to be paid to the Vendor. If this amount differs from the total charged by Vendor, be sure to give exception reason in Block 20, Receipt Exception. 20. Record receipt exception here. 21. Enter the address of the authorized official. 22. Enter signature of authorized official. 23. Enter the date this form is prepared. 24. Enter the phone number where the authroized official can be reached for additional informationn. Indicate if phone number is an FTS or commercial number. 25. Mail to this NFC address. (Use of window envelope is optional.) Attach a single invoice to the back of each AD-838B.fss