Requisition Form (DOTA) (2).xlsx

	A	B	D	E	F	G	H	I	J	K	L	M	N
1
2		POHNPEI STATE GOVERNMENT
3	REQUISITION FORM
4									Fiscal Year:
5			Date				REQUISITION NO. ____________
6	TO: DEPARTMENT OF TREASURY & ADMINISTRATION			REQUESTING DEPARTMENT:
7	TO: DEPARTMENT OF TREASURY & ADMINISTRATION			REQUESTING DEPARTMENT:
8	Prepared By:			Recommended Source:
9
10	Reviewed By:
11	ITEM	DESCRIPTION	STATE CODE	FUND	DEPT	DIVN	PROG	FY	SUB ACCT	QTY	UNIT	UNIT PRICE	TOTAL AMOUNT
12
13	1												$ -
14	2												-
15	3												-
16	4												-
17	5												-
18	6												-
19	7												-
20	8												-
21	9												-
22	10												-
23	11												-
24	12												-
25	13												-
26	14												-
27	15												-
28	16												-
29	17												-
30	18												-
31	19												-
32	20												-
33	ALLOTTEE APPROVAL		Tax 5% for merchandise, 2% for Food Items
34			MODE OF SHIPMENT									TOTAL	$0.00
35			MODE OF SHIPMENT
36	BUDGET CERTIFICATION:
37
38	Anthony Dainard, Budget Officer
39	FINANCE FUNDS CERTIFCATION
40
41
42	FINANCE USE: DATE RECEIVED		PURCHASE ORDER NUMBER							FIXED ASSET
43			PURCHASE ORDER NUMBER							FIXED ASSET
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