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<br /> - <br />I' DRAFT ONL Y - NOT FOR PA YMENT <br /> , <br /> (519/2007 - 5/16/2007) <br /> I <br /> Emereencv Equipment Deductions and Additions Invoice #: Assigned When Original is Printed <br /> (For use with OFM286 Blocks 26 and 27 - Deductions and Additions Statement) Official #: 0 I <br /> 1. CON1!t1!O~,(N? ??d EIN/SSN) 2. INCIDENT OR PROJECT NAME <br /> i fY '" FIRE DEPARTMENT HAM LAKE <br /> 20. ACCOUNTING CODE <br /> 41-6038888 P9DER5 <br /> 5. EQUIPMENT 3. AGREEMENT NUMBER <br /> Unique ID: 2004 FORD F350 250 GAL Make: 250 GAL TYPE6 ENG 00000oo04 <br /> E-128 4. REPORT DATEffIME II <br /> Request #: Model; 5/1612007 9:3 1:52AM <br /> Activitv Date Description Deductions Additions <br /> 5/11/2007 REG 23.4 GAL @ 3.155 $73.82 <br /> 5/1212007 GAS 11.6 GAL @ 3.005 $34.86 <br />.. I 5/1412007 GAS 20.3 GAL @ 3.397 $67.94 <br /> , <br /> 5/15/2007 GAS 12.8 GAL @ 3.397 $43.48 <br /> , $220.10 $0.00 <br /> Totals <br /> Page I of I <br />