EXHIBIT A
EXAMPLE PUBLIC DOCUMENT PRINTING REQUEST FORM
Name of Agency
______________________________________________________________
Mailing Address
______________________________________________________________
Quantity:
Estimated Amount $
Description of Public Document(s):
Size:
Number of pages and/or folds:
Paper* Cover:
Text:
Ink* Cover:
Text:
Binding:
Give a brief statement of why this publication needs to be printed.
I hereby certify that the above public document(s) is (are) essential to the fulfillment of the programs approved for this agency by the Appropriation Act and that funds are available to print this (these) document(s).
I am, therefore, requesting an exception as provided for in R.S. 43:31(A).
/S/ Department Undersecretary or Undersecretary's Designee
La. Admin. Code tit. 4, § V-2719