FOR TRANSPORTATION CHARGES

PARTMENT OF AGENCY, BUREAU OR SERVICE, AND LOCATION SHOWN ON SUBVOUCHERS

for Instructions on Completing this Form.

S.

.

BUR. VOU. NO.

SCHED. NO.

I certify that the account stated hereon, as evidenced by the attached subvouchers, is correct and just; that services have been rendered or tickets furnished as indicated; that payment has not been received; and that the charges are not in excess of those applicable thereto under (1) tariffs lawfully on file with any Federal or State transportation regulatory agency or (2) rates, fares and charges established pursuant to section 22 of the Interstate Commerce Act, as amended, or other equivalent contract, arrangement, or exemption from regulation.

R- GERMANY

0- VIRGINIA

AMOUNT

CARRIER'S BILL NUMBER

PAID BY

40179 A

CARRIER'S SCAC NUMBER

CRWV 11 70 Z SERVICES FURNISHED (Check one)

FREIGHT

PASSENGER

For payment of services rendered as evidenced by attached subvouchers.

PAYEE'S CERTIFICATE

I certify that the account stated hereon, as evidenced by the attached subvouchers, is correct and just; that services have been rendered or tickets furnished as indicated; that payment has not been received; and that the charges are not in excess of those applicable thereto under (1) tariffs lawfully on file with any Federal or State transportation regulatory agency or (2) rates, fares and charges established pursuant to section 22 of the Interstate Commerce Act, as amended, or other equivalent contract, arrangement, or exemption from regulation.

A-FEB 1981

TOTAL CLAIMED ►

NOV TOBU

STANDARD FORM 1113TREV. 377)

(SUPERSEDES SF 1171)

PRESCRIBED BY CSA, FPMA (41 CFR) 101 41 1113 108

*Shum also cubic measurements for shipments via

DAMAGE

bdb

NAVAL SUPPLY CENTER CODE890 437 H), HARBOR DR SAY DIEGO CA. 92132 Consignee must not pay any charges on this shipment THE (Name of delivering carrier)

Cartwright IntlVan Lines

CARRIER OSAD

REPORT ATTACHED

SERVICE FURNISHED BY CARRIER AT DESTI NATION TRAP.CAR

SIGNATURE OF CARRIER'S AUTHORIZED AGENT

DELIVERY

STANDARD FORM 1103 (REV 377

3177.

SERVICES FURNISHED (Check one)

FREIGHT

PASSENGER

For payment of services rendered as evidenced by attached subvouchers.

PAYEE'S CERTIFICATE

I certify that the account stated hereon, as evidenced by the attached subvouchers, is correct and just; that services have been rendered or tickets furnished as indicated; that payment has not been received; and that the charges are not in excess of those applicable thereto under (1) tariffs lawfully on file with any Federal or State transportation regulatory agency or (2) rates, fares and charges established pursuant to section 22 of the Interstate Commerce Act, as amended, or other equivalent contract, arrangement, or exemption from regulation.

TOTAL CLAIMED ▸

PER