I-4-2-55.Exhibit - Request for Reprographic Services

Last Update: 2/28/17 (Transmittal I-4-68)

REQUEST FOR REPROGRAPHIC SERVICES        Part 1 — Job Copy

Date Requested:

Date Required:

Serve Date:

Number of Pages Submitted:

No. of Copies Each:

Total:

Requestor:

PRB:    Section:

Phone:

Prty:

Plaintiff:

SSN:

Court:

Copy to: ODAR ___ RA ___ OGC ___

Claim File to:

Type:

R E P R O G R A P H I C S

Completed by:

Employee No.:

Case No.:

Date Received:              AM PM

Date Completed:              AM PM

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REQUEST FOR REPROGRAPHIC SERVICES        Part 2 — CCPRB Copy

Date Requested:

Date Required:

Serve Date:

Number of Pages Submitted:

No. of Copies Each:

Total:

Requestor:

CCPRB:  Section:

Phone:

Prty:

Plaintiff:

SSN:

Court:

Copy to: ODAR ___ RA ___ OGC ___

Claim File to:

Type:

R E P R O G R A P H I C S

Completed by:

Employee No.:

Case No.:

Date Received:              AM PM

Date Completed:              AM PM

------------------------------------------------------------------

REQUEST FOR REPROGRAPHIC SERVICES        Part 3 — OGC Copy

Date Requested:

Date Required:

Serve Date:

Number of Pages Submitted:

No. of Copies Each:

Total:

Requestor:

PRB:    Section:

Phone:

Prty:

Plaintiff:

SSN:

Court:

Copy to: ODAR ___ RA ___ OGC ___

Claim File to:

Type:

R E P R O G R A P H I C S

Completed by:

Employee No.:

Case No.:

Date Received:              AM PM

Date Completed:              AM PM