Creator: Date Created: Place Created: Keywords:tax papers,navy power supply Context:tax papers and information about the navy power supply ************************************************** H. TRACY HALL 1711 N. tAMBERT LANE PROVO. UTAH 84601 Typeor print EMPLOYER'S Federal Identification number, name, and addressabove. WAGE AND TAX STATEMENT (For use in States or Cities authorizing combined form) Employer's State Identification Number Copy 1—For State or City Tax Dept. FEDERAL INCOME TAX INFORMATION SOCIAL SECURITY INFORMATION Federal income tax withheld Wages paid subject to withholding in 1972 1 Other compensation paid in 1972 EMPLOYEE'S social security number ► ^ j £ 2. 2.S y Brent Fredricksen Type or print EMPLOYEE'S name and address (including ZIP code) above. Name of State Name of City State Form No. State income tax withheld City Form No. City income tax withheld i ♦See Circ. E for sick pay reporting. **Gross wages for State it different from Federal, 1 Includes tips reported by employee. Amount is before payroll deductions or sick pay exclusion. INSTRUCTIONS TO EMPLOYERS: State or city copies ol this wage and tax statement should be prepared and filed for employees in accordance with State or city instructions. FOR STATE OR CITY USE ONLY Employee's copy and employer's copy compared....._ Form W—3 Department of the"Veasury Internal Revenue Service Transmittal of Wage and Tax Statements 72 Type or Print Employer's Name and Address as It appears on Form 941, 941E, or 943 Employer Identification Number £7 o zy tf/LSr Copy for Employer or Payer A. Number of Forms W-2 or W-2(RR) transmitted ►................/........... Number showing income tax withheld ►.......P.................... B. Number of packages of forms mailed or shipped...................►............................. C. Is this an amended return?..........................► □ Yes 0 No D. Number of forms without employee's social security number................................. E. Have these employees been asked to furnish social security numbers?.............► CH Yes D No 1 Total income tax withheld as shown on Forms W-2 and W-2(RR)....... 2 Total income tax withheld as shown on Forms W-2P........... 3 Total income tax withheld (item 1 plus item 2)............. 4 Total "Uncollected employee FICA Tax on Tips" reported on Forms W-2 and W-2(RR) $ 0 $ 0 $ 0 $ 0 January 6, 1773 » Form. 941 (Rev. pet. 1972) Department ot the Treasury Internal Revenue Service Employer's Quarterly Federal Tax Return H. TRACY HALL 1711 N. LAMBERT LANE PROVO, UTAH 84601 zi-oibi?^ SGHEDULE A—Quarterly Report of Wages Taxable under the Federal Insurance Contributions Act—FOR SOCIAL SECURITY IF WAGES WERE NOT TAXABLE UNDER THE FICA MAKE NO ENTRIES IN ITEMS 1 THROUGH 9 AND 14 THROUGH 18 1. (First quarter only) Number of employees (except household) employed in the pay period including March 12th 2. Total pages of this return including this page and any pages of Form 941a ^ 3. Total number of employees listed List for each nonagricultural employee the WAGES taxable under the FICA which were paid during the quarter. If you pay an employee more than $9,000 in a calendar year report only the first $9,000 of such wages. In the case of "Tip Income" see instructions on page 4. Please report each employee's name and number exactly as shown on his Social Security card. 4. EMPLOYEE'S SOCIAL SECURITY NUMBER NAME OF EMPLOYEE (Please type or print) S. TAXABLE FICA WAGES Paid to Employee in Quarter (Before deductions) 7. TAXABLE TIPS REPORTED (See p:iee 4) It amounts In thta—. column are not tips |_| ^"^oftars Cents If you need more space for listing employees, use Schedule A continuation sheets, Form 941a. Totals for this page—Wage total in column 6 and tip total in column 7 8. TOTAL WAGES TAXABLE UNDER FICA PAID DURING QUARTER. (Total of column 6 on this page and continuation sheets.) Enter here and in Item 14 below.....$.................................. 9. TOTAL TAXABLE TIPS REPORTED UNDER FICA DURING QUARTER. (If no tips reported, Write "None.") (Total of column 7 on this page and continuation sheets.) Enter here and in Item 15 below........... Name............................................................................................................................ Date Quarter Ended . Address........................................................................................................................ Employer Identification No............. IMPORTANT.—Keep this copy and a copy of each related schedule or statement. Before filing the return be sure to enter on this copy your name, address, and identification number, and the period for which the return is filed. 10. TOTAL WAGES AND TIPS SUBJECT TO WITHHOLDING PLUS OTHER COMPENSATION 11. AMOUNT OF INCOME TAX WITHHELD FROM WAGES, TIPS, ANNUITIES, etc. (See instructions) 12. ADJUSTMENT FOR PRECEDING QUARTERS OF CALENDAR YEAR......... 13. ADJUSTED TOTAL OF INCOME TAX WITHHELD............... 14. TAXABLE FICA WAGES PAID (Item 8) . 15. TAXABLE TIPS REPORTED (Item 9) . . 16. TOTAL FICA TAXES (Item 14 plus Item 15) 17. ADJUSTMENT (See instructions) . . . 18. ADJUSTED TOTAL OF FICA TAXES . . . . %........................................... multiplied by 10.4%=TAX . $............................................multiplied by 5.2%=TAX 19. TOTAL TAXES (Item 13 plus Item 18)............................ 20. TOTAL DEPOSITS FOR QUARTER (INCLUDING FINAL DEPOSIT MADE FOR QUARTER) AND OVERPAYMENT FROM PREVIOUS QUARTER LIST IN SCHEDULE B. (See instructions on page 4)......................... Note: |f undeposlted taxes at the end of the quarter are $200 or more, the full amount must be deposited with an authorized commercial bank or a Federal Reserve bank. This deposit must be entered in Schedule B and included in item 20. 21. UNDEPOSITED TAXES DUE (ITEM 19 LESS ITEM 20— THIS SHOULD BE LESS THAN $20(1). PAY TO INTERNAL REVENUE SERVICE AND ENTER HERE ...................................—i 22. IF ITEM 20 IS MORE THAN ITEM 19, ENTER EXCESS HERE ► t AND CHECK IF YOU WANT IT □ APPLIED TO NEXT RETURN, OR Q REFUNDED. 23. If not liable for returns in succeeding quarters write "FINAL" here >■ p /Ai A L SEE "WHERE TO FILE" ON 2. and enter date of final payment of taxable wages here >■ Form 940 Department of the Jreasury Internal Revenue Service w TRACY HALL 1711 N. LAMBERT LAME PROVO, UTAH 84601 Employer's Annual Federal Unemployment Tax Return 72 SCHEDULE A—Computation of Credit Against Federal Unemployment Tax Name of State (1) State reporting number as shown on employer's Stats contribution returns (2) Taxable payroll (As defined in State act) (3) Experience rate period (4) Experience rate (5) Contributions had rate been 2.7% (col. 3X2.7%) (6) Contributions payable at experience rate (col. 3 X col. 5) (7) Additional credit (col. 6 minus col. 7) (8) Contributions actually paid to State (9) From— To— KEEP THIS COPY FOR YOUR RECORDS You must retain this copy, and a copy of each related schedule or statement for a period of 4 years after the date the tax is due or paid, whichever is the later. These copies must be available for inspection by the Internal Revenue Service. Calendar Year 1972 Identification No. Calendar Year 1972 Identification No. H. TRACY HALL 1711 N. LAMBERT LAflt PROVO, UTAH 84601 13. Total taxable wages paid during calendar year (From Schedule B, on other side) 14. Gross Federal tax (3.2% of Item 13)............. 15. Less: Credit from Item 12, Schedule A............ 16. Item 14 less Item 15.................. 17. Total tax deposited (From Schedule C, on other side)........ 18. Balance Due (Item 16 less Item 17). Pay to "Internal Revenue Service" . . 19. If no longer in business at end of year, write "FINAL" here ► General Instructions Additional instructions for withholding, depositing, paying, and reporting Federal income tax, social security taxes, and Federal unemployment tax, are contained in Circular E, Employer's Tax Guide, available free from any Internal Revenue office. Refer to Circular E to find which employers must file Form 940, the types of payments defined by law as wages, and the kind of services covered by the Federal Unemployment Tax Act. Purpose of Form 940.—This form is for the annual reporting of tax under the Federal Unemployment Tax Act. Federal unemployment tax is paid by the employer. It is not deductible from wages paid employees. The tax rate is 3.2 percent on the first $4,200 of wages paid to each employee during 1972. Who Must File.—Every employer who during the current or preceding calendar year paid wages of $1,500 or more in any calendar quarter, or had ONE or more employees at any time in each of 20 calendar weeks must file Form 940. Count all regular, temporary, and part-time employees. A partnership should not count its partners. If there is a change of ownership or other transfer of the business during the year, each employer who during the current or preceding caiendar year paid wages of $1,500 or more in calendar quarter, or had ONE or more employees at any time in each of 20 calendar weeks must file Form 940, but neither should report wages paid by the other. If you receive a preaddressed form and are not liable for Federal unemployment tax for 1972, write "Not Liable" across the front of the form and return it to Internal Revenue. If you are no longer in business at the end of a year, write "Final Return" in Item 19. If the business was sold or transferred during the year, attach a statement showing the name, and address and employer identification number (if known) of the new owner. Once you have filed a Form 940, you will be sent a preaddressed form near the close of each calendar year. If you do not receive a form, request one from any Internal Revenue office in time to file when due. Due Date of Return.—Form 940 for calendar year 1972 is due on or before January 31, 1973. However, if timely deposits were made in full payment of the tax due for the year, the return may be filed on or before February 10,1973. Where to file. If your principal business, office, or agency is located in Use this address _▼__ New Jersey, New York City Internal Revenue Service Center and counties of Nassau, 1040 Waverly Avenue Rockland, Suffolk, and HoStsville, New York 11799 Westchester_ New York (ell other coun- Internal Revenue Service Center ties), Connecticut, Maine, 310 Lowell Street Massachusett, New Andover, Massachusetts 01812 Hampshire, Rhode Island, Vermont__ District of Columbia, internal Revenue Service Center Delaware, Maryland, 11601 Roosevelt Boulevard Pennsylvania Philadelphia, Pennsylvania 19155 Alabama, Florida, Internal Revenue Service Center Georgia, Mississippi, 4800 Buford Highway South Carolina_Chamblee, Georgia 30006 Michigan, Ohio Internal Revenue Service Center ______Cincinnati, Ohio 45298 Arkansas, Kansas, Internal Revenue Service Center Louisiana, New Mexico, 3651 S. Interregional Hwy. Oklahoma, Texas__Austin. Texas 78740__ Alaska, Arizona, Colo- Internal Revenue Service Center rado, Idaho, Minnesota, 1160 West 1200 South St. Montana, Nebraska, Ne- Ogden, Utah 84405 vada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming_ Illinois, Iowa, Missouri, Internal Revenue Service Center Wisconsin 2306 E. Bannister Road _Kansas City, Missouri 64170 California, Hawaii Internal Revenue Service Center 5045 East Butler Avenue _Fresno, California 93730 Indiana, Kentucky, North Internal Revenue Service Center Carolina, Tennessee, 3131 Democrat Road Virginia, West Virginia Memphis, Tennessee 38110 If you have no legal residence or principal place of business in any Internal Revenue district, or if your principal place of business is in Puerto Rico, file Form 940 with Internal Revenue Service Center, 11601 Roosevelt Boulevard, Philadelphia, Pa. 19155. Requirements for Deposits.—Federal unemployment tax must be deposited with an authorized commercial bank or a Federal Reserve bank. A Federal Tax Deposit Form 508 must accompany each deposit. Federal unemployment tax must be computed on a quarterly basis. Any amount due must be deposited on or before the last day of the first month following the close of the quarter. (For those who do not qualify as an employer until the second or third quarter, deposit requirements do not begin until the end of the second or third quarter, respectively.) To determine whether you must make a deposit for any of the first three quarters in 1973, compute the total tax by multiplying by .0058 that part of the first $4,200 of each employee's annual wages that was paid during the quarter. If the amount subject to deposit (plus the amount subject to deposit for any prior quarter but not deposited) is more than $100, deposit it during the first month following the quarter. If $100 or less, you do not have to deposit it, but you must add it to the amount subject to deposit for the next quarter. If the tax reportable on Form 940 less amounts deposited for the year is more than $100, you must deposit the entire amount. If your tax for the year (less any deposits) is $100 or less, you may either deposit the tax or send payment with Form 940. If you deposited the proper amounts in accordance with these rules, the balance due on line 18 will not exceed $100. How to Make Deposits.—Fill in a pre-inscribed Federal Tax Deposit Form 508 in accordance with its instructions. Send the Federal tax deposit form and your tax deposit to any commercial bank depositary or Federal Reserve bank. Make your check or money order payable to that bank. The timeliness of deposits is determined by the date received in a commercial bank depositary or Federal Reserve bank. A deposit received after the due date will be considered timely if you establish it was mailed two or more days before the due date. Employer's Name, Address, and-Identification Number.—Use the preaddressed Form 940 mailed to you. If you must use one not preaddressed, type or print your name, trade name, address, and employer identification number on it. Penalties and Interest.—Avoid penalties and interest by filing a correct return and paying the proper amount of tax when due. The law provides a penalty for late filing unless reasonable cause is shown for the delay. If you file late, attach an explanation. There also are penalties for willful failure to pay tax, keep records, and make returns and for filing false or fraudulent returns. Credit for Contributions Paid into State Funds.—Employers are entitled to a credit against their Federal unemployment tax for contributions paid into a certified State unemployment compensation fund on or before the due date of Form 940. The term "contributions" means payments required by a State law to be made into an unemployment fund by any person on account of having individuals in his employ, to the extent that such payments are made by him without being deducted or deductible from the remuneration of individuals in his employ. Contributions may be credited against the tax whether or not they are paid with respect to "employment." But credit may not be taken for voluntary contributions or for penalties or interest paid to a State. The credit for contributions made after the due date (or extended due date) for filing Form 940 may not exceed 90 percent of the amount that would have been allowable if the contributions were paid on or before the due date. Employers who have been granted an experience rate lower than 2.7 percent by a State for the whole or part of the year are entitled to an "additional credit" This is equal to the difference between actual contributions and the amount they would have been required to contribute at (1) the highest rate applied by the State, or (2) 2.7 percent, whichever is lower. Under Section 3302(e) a special credit is provided if an employer during any calendar year acquires substantially all of the property used in the trade or business (or in a separate unit of a trade or business) of another person who is not an "employer" and immediately after the acquisition the successor employs in his trade or business one or more Individuals who immediately prior to the acquisition were employed in the trade or business of the predecessor. This special credit is not allowable to any successor employer whose predecessor also is an "employer," nor is it allowable to a corporation acquiring the trade or business of another corporation in a statutory merger or consolidation. The amount of the special credit is based on the amount of remuneration, subject to the unemployment compensation law of a State, paid by the predecessor to those employees who were employed by the predecessor immediately before the transfer of the trade or business (or separate unit thereof) and who also were employed by the successor immediately after the transfer. The total credit allowable under Section 3302 may not exceed 2.7 percent of taxable wages. SCHEDULE B—Computation of Taxable Wages (See Schedule B instructions on page 2) 1. Total remuneration (including exempt remuneration) PAID during the calendar year for services of employees Exempt Remuneration (Ust each type of exemption) Exempt remuneration (Explain each exemption shown, attaching additional sheet If necessary): 3. Remuneration In excess of $4,200. (Enter only the excess over the first $4,200 paid to individual employees exclusive of exempt amounts entered on line 2)............ , 4. Total exempt remuneration.......... . . ■ . Approximate number of employ*** Involved Amount paid SCHEDULE C—Record of Federal Tax Deposits Serial Number of Form 508 Data of Deposit Amount Serial Number of Form 508 Date of Deposit Amount Serial Number of Form 508 Date of Deposit Amount ItinriLs Total taxes deposited (also enter in item 17 on other side). Pas* 4 •48—10—620C&-1 Allen Webb H. TRACY HALL, Ph.D. CONSULTING CHEMIST 1711 North Lambert Lane PROVO, UTAH John Cannon October 5, 1972 Alan November 24, 1972 MEGADIAMOND CORPORATION 275 WE5T'23BD NORTH University Station, P. □. Box 1B9 PRDVD, UTAH B46D1 Phone (BOD 374-6211 \ Disbursing Officer Code 1332 Naval Research Laboratory 4555 Overlook Ave. Washington, D.C. 20390 INVOICE 12 October 1972 Kef: P.O. No. N00I73-72-M-J710 1 Power Supply Alternate Current Variable Output With Course & Fine Control Panel Meters for output volts amps 8c watts Operated on 208 V AC 15 A single phase Output 1000 amp at 2.7 volts_ custom designed with breaker switch Air freight Please make payment to H. Tracy *»all Megadiamond Corporation P.O. Box 189 University Station Provo, Utah 84601 Total Note: The original air freight bill and the original invoice were mailed to the above address on 11 July 1972 but apparently, were lost. MEGADIAMOND CORPORATION (BOD 374-6211 " < ' 275 WEST 23B□ NORTH UNIVERSITY STATION DR. H. TRACY HALL p. a. BOX1S9 P rtc s I dent provo, UTAH B4601 July 11, 1972 _| REQUEST FOR QUOTATIONS NO. RETURN COPY(IES) OF THIS QUOTE BV (THIS IS NOT AN ORDER. See DD Form 1155r) CHECKED .BOX APP£IE< ORDER FOR SUPPLIES OR SERVICES 1. CONTRACT/PURCHASE ORDER NO. N00173-72-M-J710 XG17 2. DELIVERY ORDER NO. wwrii 4. REQUISITION/PURCH REQUEST jlO, 5 CERTIFIED FOR NA TIONAL DEFENSE UNDER OMS REG 1 C9 6 ISSUED BV SUPPLY OFFICER CODE NAVAL RESEARCH LABORATORY WASHINGTON, D.C. 20390 7. ADMINISTERED BY: (If other than 6) 8. DELIVERY FOB | | DESTINATION OTHER (See Schedule if other) 9 CONTRACTOR/ CODE NAME AND ADDRESS QMega rfBSK DIAMOND CORP BOX 189 UNIVERSITY STATION PROVO, UT 84601 FACILITY CODE 10. DELIVER TO FOB POINT BY: 72 JUN 30 1 1. CHECK IF SMALL BUSINESS 12. DISCOUNT TERMS 13. MAIL INVOICES TO. BLOCK 15 14. SHIP TO: CODE RECEIVING OFFICER NAVAL RESEARCH LABORATORY 4555 OVERLOOK AVE. S.W. WASHINGTON, D.C. 20390 5. PAYMENT WILL BE MADE BY: r, DISBURSING OFFICER NAVAL RESEARCH LABORATORY 4555 OVERLOOK AVE. S.W. WASHINGTON, D.C. 20390 MARK ALL PACKAGES AND PAPERS WITH CONTRACT OR ORDER NUMBER This delivery order is subject to instructions contained on this side of form only and is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract. TELCOI'l 72 liAR 22 HALL PURCHASE Reference your furnish the following on terms specified herein, including. for.U. S. purchases. General Provisions of Purchase Order on DD Form 1155r (Except CLAUSE NO. 13 APPLIES ONLY IF THIS BOX Q IS CHECKED, and NO. 15 IF THIS BOX | | IS CHECKED); special provisions : and delivery as indicated. This purchase is negotiated under authority of 10 USC 2304(a) (3) or as specified in the schedule if within the U. S., its possessions or Puerto Rico; if otherwise, under 2304(a) (6). If checked. Additional General Provisions apply; Supplier shall sign "Acceptance" on DD Form 1155r and return copies. ACCOUNTING AND APPROPRIATION DATA—ACCOUNTING CLASSIFICATION (REV. 7-65) Item No. App'n and Subhead Obj. Class. Bureau Cont. No. Sub allot. Auth'n Acct'g Act'y Trans. Type Property Acct'g Act'y Country ALL 17X4912.1403 000 77777 NO 01 73 2E SCHEDULE OF SUPPLIES/SERVICES 20 QUANTITY ORDERED/ ACCEPTED # 21. UNIT AMOUNT CONFIRMATION OF ORDER MATERIAL PER ATTACHED SHEET/S 64-0522-72 64P03-06 *lf quantity accepted by the Government is same as quantity ordered, indicate by \/ mark. If different, enter actual quantity accepted below quantity ordered and encircle. 56462 26. QUANTITY IN COLUMN 20 HAS BEEN ^RECEIVED | | INSPECTED 1 ,200.00 D LCDR SC USN CONTRACTING/ORDERING OFFICER ACCEPTED, AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED (Date) (Signature of Authorized Government Representative) 36. I CERTIFY that this account is correct and proper for payment. (Signature and Title of Certifying Officer) . SHIP. NO. Q PARTIAL □ FINAL 31. PAYMENT □ COMPLETE □ PARTIAL □ FINAL 28. D. O. VOUCHER NO. 32 PAID BY 25. TOTAL 1,200.00 DIFFERENCE^ 30. INITIALS 33 AMOUNT VERIFIED CORRECT FOR 34. CHECK NUMBER 35. BILL OF LADING NO. 37 RECEIVED AT 38 RECEIVED BY 39. DATE RECEIVED 40.TOTAL CONTAINERS 41. S/R ACCOUNT NUMBER 42 S/R VOUCHER » Av-> cP> oAp / DD i A°GM66 1155(8C)s/N0 102 011 3101 Form Approved by Comptrol' Exception to SF 18 under $2500 App- STANDARD FOP^A 36, JULY 1966 GENERAL SERVICES ADMINISTRATION FED. PROC. REG. (41 CFR) 1-16.101 CONTINUATION SHEET REF. NO. OF D^g J^fS ^^f Q N001 73- PAG!t)2 |OF 02| NAME OF OFFEROR OR CONTRACTOR ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT POWER SUPPLY KMKRRNX I H EAI ALTERNATE CURRENT VARIABLE OUTPUT WITH COURSE & FINE CONTROL PANEL METERS FOR OUTPUT VOLTS, AMPS AND WATTS OPERATED ON 208 VAC 15A Xa SINGLE PHASE OUTPUT 1000 AMP AT 2.7 VOLTS - CUSTOM DESIGNED WITH BREAKER SWITCH. 1,200.00 1,200.0d F.O.B. PROVO, UT SHIP PREPAID VIA AIR CHARGES TO BE ADDED AS A SEPARATE ITEM dN CONTRAlCTOk S INVOICE AND SUBSTANTIATED BY AN ORIGINAL^ PAID RECEIPT FREIGHT CONTR CERT IF I t D NAVAL RESEARCH LABORATORY WASHINGTON. D.C. 20390 IN REPLY REFER TO: 6430-AWW:jbq 13 March 1972 H. Tracy Hall High Pressure Laboratory B-41 Brigham Young University Provo, Utah 84601 Dear Tracy, A purchase order is in the mill here for the power supply we talked about. One question which has come up concerns the source voltage. For some reason! 220V is very rare here and most of the lines are 208V, until one of our brown-outs reduces even that. This has caused grief numerous times with new equipment, especially motors and electronics. The transformer should be chosen with this in mind. The power people here think this should be possible as 208V is common in the East. I realize that this would probably delay completion, and must accept the delay. I would caution you, however, not to do any ordering until you received word from our Supply since they can tangle things up rather badly at times. It was a pleasure to talk to you last week. I would like to find some excuse to come out there, but haven't yet. We were up to the Temple site here this weekend, and they have the forms for the walls of the first floor, with the basement fully cast. Thanks for your help. Sincerely, Alan Wendell Webb Crystal Physics Branch Solid State Division MEGADIAMOND CORPORATION 275 WEST '23BD NORTH University Station, P. □. Box 1B9 PROVO, UTAH B4601 phone (BD1) 374-6211 Disbursing Officer Code 1332 Naval Research Laboratory 4555 Overlook Ave. Washington, D.C. 20390 12 October 1972 Ref: P.O. No. NOO173-72-M-J710 INVOICE 1 Power Supply Alternate Current Variable Output With Course & Fine Control Panel Meters for output volts amps & watts Operated on 208 V AC 15 A single phase Output 1000 amp at 2.7 volts_ custom designed with breaker switch 31200.00 l Air freight 67.29 Please make payment to H. Tracy Hall Megadiamond Corporation P.O. Box 189 University Station *Vovo, Utah 84601 Note: The original air freight bill and the original invoice were mailed to the above address on 11 July 1972 but apparently were lost. Total $1267.29 uniform ajr81ll non-negotiable S«6»ci !i o* CMlrad m Sift »(* g» Art* dg ^ Sua j CGNiiGNtE S ACCOUNT WUMcicH consignee r/o I'^JaL research lab STREET ADDRESS 4555 OVERLOOK AVE. S.'J. d r. ■ D€'l-ZONE cUniicdAir Lines . P. O. Box 66100 Chicago, Ultnoit 6O066 D OT . iiu I iCN E - INSURANCE <3 - SIGNATURE SERVICE H - S'EPAPJ>TE/EARLY RELEASE M - MISCELLANEOUS . SERVICE CHARGE P - PACKAGING S - STORAGE T - SHI? SAl.ES TAX X -.UNAS3i:„\EO RFC - PFM--ANCE FOLLOWING . COLLECTION ai'fcClAu jKi'H^CT.ONS 'V.:---'vi LuiLMEK KtrtHLtCt N - ............ _ CARRIER USE ONLY RATE CHARGES WEIGHT CHARGES $ . 6a' PICK UP DELIVER? 5V? SHIPPER S ACCOUNT NUMBER 999 NAME TRA'vi 1-iVuIl STREET ADDRESS EXCESS VALUE ^ shipper y CUBIC INCHES DIMENSIONAL WGT-LBS -.0. BOX 189 UTT7ZR3ITY STillOi: C.O.D. Shipment mmxxsrerix FRC^G, utaH. if amount entered here by Shipper Pitt jp ZONE ORlG. ADVANCE CrfGi DiLSCfllpriON Of Orl.uiN ADVANCE ChA-uc-; ■ AL'VANCc Cm— ; D6^CR»PT»ON Of 26ST.NA TION AL^ ANCE CHAhCiES ■ IF I! CARRIER , ORlGiN 'THIS IS NOT AN INVOICE 016 5605 4574 1. SH':-DE~.S VAC 2141 »€V 11-71 lACJT) P«tNT£D iN U SA