Dd Form 1149 - Requisition And Invoice/shipping Document - 2003
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1
2SHIPPING CONTAINER TALLY
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Form Approved
REQUISITION AND INVOICE/SHIPPING DOCUMENT
OMB No. 0704-0246
Expires Feb 28, 2006
The public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services,
Directorate for Information Operations and Reports (0704-0246), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any
penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THIS ADDRESS. RETURN COMPLETED FORM TO THE ADDRESS IN ITEM 2.
1. FROM: (Include ZIP Code)
SHEET
NO. OF
5. REQUISITION
6. REQUISITION NUMBER
NO.
SHEETS
DATE
DMRTI
7. DATE MATERIAL REQUIRED (YYYYMMDD)
8. PRIORITY
Trauma Education Dept
20151029
4270 Gorgas Cir Fort Sam Houston, TX 78234
2. TO: (Include ZIP Code)
9. AUTHORITY OR PURPOSE
TCCC
DMRTI Logistics
4270 Gorgas Cir
10. SIGNATURE
11a. VOUCHER NUMBER & DATE (YYYYMMDD)
Fort Sam Houston, TX 78234
12. DATE SHIPPED (YYYYMMDD)
3. SHIP TO - MARK FOR
b.
13. MODE OF SHIPMENT
14. BILL OF LADING NUMBER
15. AIR MOVEMENT DESIGNATOR OR PORT REFERENCE NO.
4. APPROPRIATIONS DATA
AMOUNT
National Association of EMTs (NAEMT)- Tactical Combat Casualty Care (TC3). This is for provider and instructor updated hand references for courses for
FY15 contract.
ITEM
UNIT
QUANTITY
SUPPLY
TYPE
CON-
NO.
FEDERAL STOCK NUMBER, DESCRIPTION, AND CODING OF MATERIEL AND/OR SERVICES
OF
REQUESTED
ACTION
CON-
TAINER
UNIT PRICE
TOTAL COST
ISSUE
TAINER
NOS.
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
TCCC Guidlines For Medical Personnel print size of pages 4''x5.5'' in black print all
1
EA
100
pages laminated on both sides of pages. Coil bind all pages on right hand side with a
tan cover sized 4''x5.5'' with black letters "TCCC Guidelines" with emblem printed
2
in color on front cover above TCCC Guidline text.
3
4
5
16. TRANSPORTATION VIA MATS OR MSTS CHARGEABLE TO
17. SPECIAL HANDLING
18.
ISSUED BY
19.
DATE
BY
SHEET TOTAL
TOTAL
TYPE
TOTAL
TOTAL
CONTAINERS
DESCRIPTION
CON-
CON-
(YYYYMMDD)
R
WEIGHT
CUBE
RECEIVED
TAINERS
TAINER
E
O
0.00
EXCEPT AS
C
F
R
A
NOTED
E
P
S
CHECKED BY
DATE
BY
GRAND TOTAL
C
QUANTITIES
I
H
(YYYYMMDD)
T
I
E
RECEIVED
U
P
EXCEPT AS
I
L
M
NOTED
P
A
E
PACKED BY
DATE
BY
20. RECEIVER'S
T
N
T
VOUCHER NO.
(YYYYMMDD)
I
T
POSTED
O
N
TOTAL
DD FORM 1149, JUN 2003
100
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PREVIOUS EDITION IS OBSOLETE.
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