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Re Other Request #2 Attachment 2 6 2017 Redacted PDF

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Preview Re Other Request #2 Attachment 2 6 2017 Redacted

Office of Administration Commissioner's Office “Request for Preauthorization for Other Services" Program: Alternatives te Abortion Contractor:___ a ce Subcontractor: CCKC=$t jaseph_ Pluase enter belovr the information foreach itemy/'setviee tobe purchased. Listthe date of purel:ase, item to be purchased, cost for the item, ard the jusification, Items must be approved before purchasadi/provided to be reimbursed core Ne ote Erodes Proposed Purchase Ten Total Gost) fustifzatian,wrluce | Date (include oF finding furmal n attempted stioate from provider of services) - capvEye ‘Watinset eri matress 35499 Gientin need afwerib (spsing col) iasiead uF pack paltress rather tha & play tc use:n her own ers program purchasing # lia stval bedroom. cost is pace n play far ber, per less than usuel packn play her request Shebas no rrrehased, funds oy other resources available to pay for mattress Bahy dae 3/03/37, | Fmauntto be ia 1 roursbursed Please return ta Alternatives to Abortion Program Manager, State of Missuuri Office of Administration, Commissioner's Office, State Capitul Building, Room, 125, Jefferson City, MO 65101. May be faxed to 573/751-1212 ur emolled to emily.roftGiad.ma,ov. by the Comactoruntyt j Authorized person requesting purchase:fh Approved for purchase fi Date Purchase denied: Date Reason for denying purchase Search FRE hipping on $504 ondors i Get tips and shop products for every stageot your bal Qe —— $44.99 Dream 01 Me ner Spring Pay “aa ) vuscaun 90 we 3° Spiing Coil Portable Crib Mattress - Welmart.com BooRcitem o¥ Inger hr Fo anny naam eeepc eng SAE cynsnere arcsec onan ee ta ‘somite pec tonne an Tremor eng colle eb tes nent ql. Yoo longer nec tase aside cba gate cootitan spy ots flanenmton tron ee fester ste co at ore poeta poate hone eee tno ove vi latching. Thsolapicypeaame cwbsdelsironrcone Wen ton Sinaldmlieantoderac cast oercear wthoumcraamivoon tieserea vee onset qty vin tara ara este sh eadannaeeroe kant torts Dane tasencanee sie panies hidasiworw walenart.conv/py23890715? mnlspartner=wmtlabs@adid=2272222222201727.... 1/10/2017

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