MATERIAL REQUISITION/ISSUE/RECEIPT
Type of Transaction	Project Materiel	Other (specify)
("X" one)	Operating Materiel
X	In Use Personal Property
PART A -- REQUISITION/TRANSFER
Trans	Voucher Number	Supply Support Code	Cost Center
Requisition Number	Cond Code	Job Order Number	Date Required	PRI	Facility Type
Approved By/Title	Outgoing No.	Incoming No.	Date
Method of Shipment (Include final carrier, if known)	Batch No.
Mark For	Date Prepared	GBL Number	No. of Packages
NWP Disposal
SHI P T O	Consi gnee	National Wireless Program, AMK-270 6500 S. MacArthur Blvd. MPB 121 Oklahoma City, OK 73169	F ROM	Consi gnor
PART B -- PROJECT MATERIAL KEY PUNCH SOURCE DATA
RG	AR	Cost Center	MC	Cost Code	Job Order	GSA Address	WH	FS	Trans	TR	Contract/Document No.	PC
PART C -- UNIT IDENTIFICATION
Item No.	National Stock No.	Equipment Type	Item Description	Asset	Quantity	UI	Unit Price	Total Cost
1
PART D -- IN USE PERSONAL PROPERTY KEY PUNCH SOURCE DATA
ATS Loc	Std. Fac. Ident.	OW	R	A	Cost Center	Act'n Date	Document No.	Trans.
A	E	X	C	H	D	Q	1	G	R	7	0	1
0	0	0	0
Accounting Classification	Reimbursement Required	Total
Yes	No
All Items Received, Except As Noted (Signature)	Title	Date
Delegate
FAA Form 4650-12 (7/87)	Page No.	1	of	1	pages

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