| (H) 734-846-8404 | (O) |
| 借用單位 | The Singapore Students' Association, University of Michigan | 負責人 | Jia Ying Tay | ||||||||
| 服飾名稱 | 數量 | 服飾內容 | |||||||||
| Lion Dance Costume | 2 | for two middle sized males | |||||||||
| Lion Head | 1 | "Life size" | |||||||||
| Drums | 1 | Big drums inclusive of drumsticks | |||||||||
| Cymbals | 1 | A pair of cymbals | |||||||||
|
|
|
|||||||||
|
|
|
|||||||||
| 申請日期 | 01/16/2005 | 使用日期 | 03/12/2005 | ||||||||
| 領取日期 | 03/05/05 | 歸還日期 | 03/19/2005 | ||||||||
| 申請人 | Jia Ying Tay | 電話 |
| ||||||||
| 駕照號碼 | T000414955386 | SS# | 377-29-7091 | ||||||||
|
503 Church Street Apt 8 | ||||||||||
| Ann Arbor, MI 48104 | |||||||||||
| |
申請人簽名： 承辦人簽名： | |