CHECK DISBURSEMENT VOUCHER
Date:
Amount:
Payee:
Address:
City, State & Zip:
INVOICE DATE
INVOICE NUMBER
FUND
ORG
ACCOUNT
PROG
If you must scroll right to see this column, use the
alternate form
.
NET AMOUNT
DESCRIPTION:
TOTAL:
(Be sure all lines are visible in printed copy.)
DEPARTMENT APPROVAL
(must include printed name and e-mail)
SPECIAL INSTRUCTIONS
(Be sure all lines are visible in printed copy.)
__________________________
____________
Signature
Date
PRINTED name:
E-mail address:
[ Print-only version of CDV ]
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