Requisition No.
To Branch of Procurement & Contracts MS 205	Bureau/Office USGS/WMA/NRP/EB
Date
Appropriation/Allotment No.	Charge shipping costs to
Vendor	Deliver to
ITEM OR FORM NO	DESCRIPTION	QUANTITY	UNIT	UNIT PRICE	AMOUNT
To Be Completed by Fiscal Authority Only
FUND CERTIFICATION: Funds in the amounts shown are available and chargeable to the cost authorities shown above.
Signature	Date	Approved by (Signature)	Date
Title Melissa L. Schomody, Administrative Officer, NRP/EB	Title Pierre D. Glynn, Chief, NRP/EB
Requisition by (Signature)	Date	Bureau Officer (Signature)	Date
Title	Title

Page	of

Form DI-1 UNITED STATES

(rev. April 1985) DEPARTMENT OF THE INTERIOR

REQUISITION