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* Payee Name: |
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* Submit
Date:
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Mail To Name:
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Check #:
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* Street Address: |
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*
Date Paid:
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* City/State/Zip: |
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*
Tres. Signature
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E-mail: |
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* Home Phone: |
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| 3010 - Designated
Funds
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3020 - General Funds |
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For Income please select one
from either 4000 - Income or 5000 - Sales |
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For Expense please select one from the 6000 |
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For Other Expense please select the 7000 |
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Comments/ Explanations:
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Preferred Contact Method
-
It additional information is need
how would you perfer we contacted you. Please select one
below. Thank You
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Submitted By:
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Phone:
-- |
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Approved By:
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Title:
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