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INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date
INVENTORY CUSTODIAN SLIP

Entity Name:
Fund Cluster: ICS No:
Amount Estimated
Quantity Unit Description Item No.
Unit Cost Total Cost Useful Life

Received From: Received By:

JONEL A. ROLDAN
Signature Over Printed Name Signature Over Printed Name

Acting OIC-GSO
Position/Office Position/Office

Date Date

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