MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C649DF.92B2E4D0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C649DF.92B2E4D0 Content-Location: file:///C:/272AD630/CommodityTransferofProductReport00.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" COMMODITY TRANSFER OF PRODUCTREPORT

EXHIBIT H

Name of Outlet Transfe= rring Product: _______________________________________________  Date:____________

Name of Outlet Receivi= ng Product: __________________________________________________

Prepared by:_____________________________   Name of Outlet _______________________________

Date Report Prepared:_____________

Telephone:____________= ___________        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;        

Approved by RA: _______________________________________________ Date Approved: _______

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  RA Signature

PRODUCT(S)

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Product Transferred

From

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Total

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Product Received

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Total

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Note:  A copy must be kept on file at each outlet and the RA. 

NO PRODUCT CA= N BE IN AN OUTLET MORE THAN 6 MONTHS

      = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;     

 

------=_NextPart_01C649DF.92B2E4D0 Content-Location: file:///C:/272AD630/CommodityTransferofProductReport00_files/header.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

INDIANA FAMILY AND SOCIAL SERVICES ADMINISTR= ATION

HOUSING AND COMMUNITY SERCVICES SECTION

COMMODITY AND/OR OTHER ITEMS TRANSFER OF PRODUCT REPORT

PREPARED BY: M McGraw

RUN DATE: 11/02

FILE NAME: COMMODITY TRANSFER OF PRODUCT

 

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