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Okaloosa County BOCC — March 18, 2014 — Airgas Invoice-Dec 2013 — reading text
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reverse side of this form.
PLEASE MAKE CHECKS PAYABLE AND REMIT TO:
Midis fy Aa Lo TR Wo TUT cere TF
BILLTO. ATTN ACCOUNTS PAYABLE
. OKALOOSA CO EMS AIRGAS USA, LLC
Pat 90 COLLEGE BLVD E PO BOX 532609 VA
g NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609
000628
4291.591159500156049700003181548
TO ENSURE PROPER CREDIT, PLEASE RETURN THE RES EARI We PORTION woH YOUR REMITTANCE, FOR QUESTION: ON ee
SOLD T TERNS:
g 5 TAGE:
ee
SUMMARY PAGE
Sales Sold Ship Ship To Name Region Inv Delivery Invoice Amount
Org To To Num Number
$000 1291991 1288928 OKALOOSA COUNTY EMS 9022984941 8023739306 64.14
S000 1291991 1288928 OKALOOSA COUNTY EMS 9023004550 8023762473 121.11
$000 1291991 1288928 OKALOOSA COUNTY EMS 9023004551 8023521483 6.33
S000 1291991 1288928 OKALOOSA COUNTY EMS 9023004552 8023782165 68.28
$000 1291991 1288928 OKALOOSA COUNTY EMS 9023004553 8023782169 32.49
SoO00 1291991 1288928 OKALOOSA COUNTY EMS 9023071143 8023795637 57.81
S000 1291991 1288928 OKALOOSA COUNTY RMS 9023087633 8023811280 26.16
S000 1291991 1288928 OKALOOSA COUNTY EMS 9023087634 8023811281 66.90
S000 1291991 1288928 OKALOOSA COUNTY EMS 9915684755 N/A 1,031.06
ship To: $ 3,181.94
Airgas OKALOOSA COUNTY EMS
www.airgas.com CHRISTOPHER D TANNER, MD
90 COLLEGE BLVD E Ans Bo0e074182
Airgas USA, LLC NICEVILLE FL 32578-1343 Ne Be
PO Box 9249
Marietta, GA 30065-2249
PNC Bank, ABA No 031000053
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